Behavioral Health Utilization Management Care Coordinator

Norfolk, VA
Nov 14, 2018
Jan 24, 2019
Healthcare, Other
Full Time

Optima Health Community Care is hiring for a Behavioral Health- Utilization Care Coordinator in Norfolk, VA. This position is expected to transfer to Virginia Beach in the next 6 months to help our Hospital Review Team.


Monday - Friday, 8am-5pm

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!

2 years experience working in behavioral health and 1 years¿ experience with behavioral health care coordination, discharge planning, continuity of care or transitions of care required. LCSW or LPC or LMFT or RN current license for the state of Virginia. LMHP- S, LMHP-R may be considered if actively working towards licensure and prior experience is present


Behavioral Health Utilization Management Care Coord 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 managed care contracting, Medical Necessity, CMHRS services, BH and ARTS 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.


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

Required: Clinical - 2 years

Preferred: Case Management - 1 year

Required: License Clinical Social Worker, License Professional Counselor, Registered Nurse

Preferred: None, unless noted in the "Other" section below


Preferred: None, unless noted in the "Other" section below

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