Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN for Weekends- Remote in VA and NC!

At Sentara, one of our values is to keep you safe. Sentara and many other companies across the US are being targeted by cyber criminals who are impersonating representatives of the company, claiming to have job offers. Sentara will never ask you for banking or personal identification information via email or text. We will never ask an applicant to pay money for training, supplies, or other so-called expenses. If you suspect you have received a fraudulent job offer, e-mail taadmin@sentara.com. Award-winning: Sentara is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!

Status: Full-time, permanent position (40 hours) Work hours: Flexible dayshift; Can start from 6am to 9am EST for a 10 hour shift (Thursday to Sunday); Location: Fully remote in Virginia OR Northeast North Carolina.

Behavioral Health Utilization Management clinician 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 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.