Sentara Health Plans is hiring for a Behavioral Health Utilization Management Care Coordinator- Whole Person Care- Hybrid in Central Virginia!

Position Status: Full-time permanent (40 hours/week)

Position Location: This is a hybrid role based in Central Virginia (Fredericksburg Petersburg Richmond Henrico and nearby areas). The role includes travel of up approximately 2 days per week in the community (home CSB or hospital visits as needed) and 3 days working from home.

Standard Working Hours: 8 AM to 5 PM EST M-F

Overview

Behavioral Health Utilization Management Care Coordinator is responsible for review of clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed. Requires knowledge of managed care contracting Medical Necessity CMHRS services BH and ARTS services DMAS protocols clinical protocols and clinical review requirements. Requires knowledge of contractual regulatory and compliance requirements for government payers self-funded and commercial payers. Ensures appropriate and accurate information is entered into the claims system for processing of payment.

Education

• Masters degree in Counseling Social Work or Marriage and Family Therapy . For Registered Nurses a Bachelor of Science in nursing is .

Certification/Licensure

license must be valid in state of practice. One of the following qualifies:

• Licensed Clinical Social Worker (LCSW) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Clinical Social Worker (LCSW) - State license - North Carolina Social Work Certification and Licensure Board (NCSWCLB) OR

• Licensed Professional Counselor (LPC) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Professional Counselor (LPC) - State license - North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC) OR

• Licensed Marriage and Family Therapist (LMFT) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Marriage and Family Therapist (LMFT) - State license - North Carolina Marriage and Family Therapy Licensure Board (NCBMFT) OR

• Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Single State - Nursing License - North Carolina Board of Nursing (NCBON) OR Registered Nurse (RN) Multi State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Multi State - Nursing License - North Carolina Board of Nursing (NCBON)

Experience

• 2 years of behavioral health (Required)

• 1 year of case management (Required)

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans as well as Individual & Family Health Plans Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network including specialists primary care physicians and hospitals.

We offer programs to support members with chronic illnesses customized wellness programs and integrated clinical and behavioral health servicesall to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People Quality Patient Safety Service and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply please go to and use the following as your Keyword Search: JR-88584

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Talroo Health Plan

Managed Care MCO Health Plan Healthcare Masters Social Work Counseling Field BSN Nursing Licensed Clinical Social Worker (LCSW) Licensed Professional Counselor (LPC) Licensed Marriage and Family Therapist (LMFT) Registered Nurse License (RN) Clinical behavioral health care coordination case management Hybrid Central Virginia Fredericksburg Petersburg Richmond Henrico