Board Certified Behavior Analyst, Behavioral Health Utilization Management

Job not on LinkedIn

🔥 19 hours ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Apply critical thinking and clinical knowledge to behavioral health utilization management • Interpret criteria, policies, procedures, and complex clinical issues to determine appropriate services • Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members • Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and judgment to render coverage decisions • Coordinate with providers and other parties to facilitate optimal care and educate them on clinical necessity concerns and ABA compliance requirements • Identify members at risk for poor outcomes and facilitate referrals to other products, services, and programs • Identify opportunities to promote quality and effective healthcare services and benefit utilization • Consult with internal and external constituents on utilization and benefit management • Ensure accurate information is entered into the claims system for payment processing

🎯 Requirements

• Master's Level Degree REQUIRED • Board Certified Behavior Analyst (BCBA) REQUIRED • Licensed Behavioral Analyst in Virginia (LBA) REQUIRED • Knowledge of managed care contracting, medical necessity, Mental Health Services (MHS), behavioral health services, DMAS protocols, clinical protocols, and clinical review requirements REQUIRED • Knowledge of contractual, regulatory and compliance requirements for government payers, self-funded and commercial payers REQUIRED • ABA (applied behavior analysis) with ASD (autism spectrum disorder) experience REQUIRED • 3 years of related experience REQUIRED • Health Plan experience preferred • Must work remotely from Virginia only • Standard working hours: 8am to 5pm EST, Monday-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 • Pet Insurance • Legal Resources Plan • Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met