Social Worker (LCSW) or Counselor (LPC) or Registered Nurse (RN)
Monday - Friday, 8am-5pm
In this office-based position, the Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC) will provide community mental health documentation review for the continuation of services in our Medallion Program. LCSWs and LPCs will have a background of a minimum 2 years of clinical experience rooted in mental health, behavioral health and substance abuse disorders; bringing a wealth of clinical experience and knowledge base to this rewarding desk position. This unique team is comprised of clinical professional staff, behavioral health clinicians, and non-clinical staff. We have an integrated care model which encompasses care plans and address our members' medical health, addiction, recovery and treatment. Minimum Master's degree required and at least 3 years of experience working with vulnerable populations. Community Mental Health and Rehabilitative Services (CHMHRS) experiences is preferred.
Registered Nurses (RNs) in this role will have a background rooted in mental health, behavioral health and substance abuse; bringing a wealth of clinical experience and knowledge base to this rewarding desk position. We have an integrated care model which encompasses care plans and address our members' medical health, addiction, recovery and treatment. Minimum BSN degree required and at least 3 years of RN experience, preferably in case management. Community Mental Health and Rehabilitative Services (CHMHRS) experiences is preferred.
Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.
As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission “to improve health everyday.” This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support -every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.
Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!
Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!
Responsible for review of clinical information received from Community Mental Health and Rehab Service Providers and other Clinical providers ensuring clinical data is substantial enough to authorize services. Analyzes clinical information to ensure the services requested are authorized according to DMAS clinical protocols. Responsible for validation of member benefits for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services. Requires knowledge of managed care contracting, CMHRS services, DMAS protocols for such services, clinical protocols and clinical review requirements. Requires knowledge of 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.
Master's Level Degree - COUNSELING OR
Master's Level Degree - SOCIAL WORK
RN-Bachelor's Level Degree
Required: Clinical - 2 years for LPC/LCSW
Required: Nursing - 3 years for RN
Required: License Clinical Social Worker, License Professional Counselor, or Registered Nurse
Required: Communication, Critical Thinking, Service Orientation
2 years of Clinical experience working with mental health and substance use disorders acute or assessment is required. CMHRS experience preferred. 3 years of experience working with vulnerable populations is required. BLS certification preferred.
For RN Integrated Care Management departments, specialty certification required within one year of eligibility (ACM, CCM, CCCTM or RN-BC). For other service lines, certification based on specialty area required within one year of eligibility. 3 years Case Management experience preferred
Keyword: CMHRS, LPC, LCSW, Counseling, Social Work, Insurance Authorizations, Managed Care, Substance Abuse, DMAS, CCC+, Registered Nurse, RN