Behavioral Health Utilization Management Clinician, LCSW, LPC, LMFT, RN, LSATP
Posted 3ds ago
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Job Description
Behavioral health utilization clinician reviewing substance-abuse services for Sentara’s Virginia health plan. Applying medical-necessity criteria and payer regulations to authorize care.
Responsibilities:
- 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
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