Social Worker or Counselor - Pre- Authorizations

Norfolk, VA
Jul 13, 2018
Aug 20, 2018
Full Time
Job Description: Optima Health Community Care is hiring a Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC) for the role of Pre-Authorization Coordinator in Norfolk, VA.


Monday - Friday, 8am-5pm

Department/Position Overview:

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.

Division Highlights:

Optima Health Community Care is a Commonwealth Coordinated Care Plus (CCC Plus) Medicaid plan for many older people and those with disabilities. CCC Plus is a Medicaid managed care program through the Virginia Department of Medical Assistance Services (DMAS).

With Optima Health Community Care, members benefit from an individualized, fully-integrated program with a state-wide network of providers. As an Optima Health Community employee, you will join a care team committed to providing customized and personalized support and services in the community that our members can count on. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.

Sentara Benefits:

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.

Education Level
Master's Level Degree - COUNSELING OR
Master's Level Degree - SOCIAL WORK

Required: Clinical - 2 years

Preferred: None, unless noted in the “Other” section below

Required: License Clinical Social Worker, License Professional Counselor

Preferred: None, unless noted in the “Other” section below


Preferred: None, unless noted in the “Other” section below

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.

Keyword: CMHRS, LPC, LCSW, Counseling, Licensed Clinical Social Worker, Licensed Professional Counselor, Social Work, Insurance Authorizations, Managed Care, Substance Abuse, DMAS, CCC+

Equal Opportunity Employer