Behavioral Health Utilization Management Clinician, LCSW, LPC, LMFT, RN

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🕒 5 days ago

🌲 North Carolina, Virginia – Remote

🌲 North Carolina – Remote ⚔️ Virginia – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

✨ Clinician

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Sentara Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1890

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Sentara Health is a leading healthcare system that operates over 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals. The company is dedicated to providing exceptional patient care, fostering professional development, and maintaining a diverse workforce. Sentara Health aims to improve health every day and has been recognized for its clinical and operational performance, being named one of the top 15 health systems by IBM Watson Health. The organization supports its employees in achieving their full potential and encourages growth and innovation in the healthcare sector.

📋 Description

• Review clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed • Requires knowledge of medical necessity criteria for behavioral health and substance use 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 claims system for processing of payment.

🎯 Requirements

• Master's degree in Counseling, Social Work, or Marriage and Family Therapy REQUIRED • For Registered Nurses, a Bachelor of Science in nursing is REQUIRED • Certification/Licensure REQUIRED 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) • Licensed Substance Abuse Treatment Practitioner (LSATP) OR Certified Substance Abuse Counselor (CSAC) OR Licensed Chemical Dependency Counselors (LCDC) preferred • 2 years of behavioral health REQUIRED • 1 year of case management REQUIRED • Experience in substance abuse in American Society of Addiction Medicine (ASAM) levels of care) and utilization management preferred

🏖️ Benefits

• Medical, Dental, Vision plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • Paid Time Off and Sick Leave • Paid Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education • Student Debt Pay Down – $10,000 • Reimbursement for certifications and free access to complete CEUs and professional development • Pet Insurance • Legal Resources Plan • Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.