Behavioral Health Utilization Management Care Coord

Location
Norfolk, VA
Salary
Competitive
Posted
Jan 24, 2019
Closes
Mar 02, 2019
Ref
120385BR
Function
Other
Industry
Healthcare, Other
Hours
Full Time
Overview:

Optima Health is hiring for a Behavioral Health Utilization Care Coordinator in Norfolk, VA.

Hours/Shift:

Monday - Friday, 8am-5pm

Division Highlights:

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 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!



Other
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

Responsibilities:

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.

Qualifications:

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

Experience
Required: Clinical - 2 years

Preferred: Case Management - 1 year

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

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

Skills
Required:

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

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