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

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🔥 2 minutes ago

🌲 North Carolina, Virginia – Remote

🌲 North Carolina – Remote ⚔️ Virginia – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

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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 to ensure clinical data is substantial enough to meet Medical Necessity Criteria and authorize services as needed • Apply medical necessity criteria for behavioral health and substance use services, DMAS protocols, clinical protocols, and clinical review requirements • Apply contractual, regulatory, and compliance requirements for government, self-funded, and commercial payers • Ensure appropriate and accurate information is entered into the claims system for payment processing • Support behavioral health utilization management for substance abuse services

🎯 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 • Must hold a valid license in the state of practice • One qualifying credential required: LCSW, LPC, LMFT, RN single-state or multistate nursing license, LSATP, CSAC, or LCDC • 2 years of behavioral health experience required • 1 year of case management experience required • Experience with substance abuse across American Society of Addiction Medicine (ASAM) levels of care preferred • Experience in utilization management preferred • Knowledge of behavioral health and substance use medical necessity criteria • Knowledge of DMAS protocols, clinical protocols, and clinical review requirements • Knowledge of contractual, regulatory, and compliance requirements for government, self-funded, and commercial payers • Ability to work flexible dayshift hours, starting between 6am and 9am EST, Monday through Friday

🏖️ 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 • Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met • Flexible dayshift work hours