Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management- Remote in VA!

City/State

Work Shift

Overview:

Sentara Health is hiring for a Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management- Remote in VA!

Job Profile Summary:

• Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, understanding complex issues and policies and procedures to determine the best and most appropriate services.

• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.

• Coordinates with providers and other parties to facilitate optimal care/treatment and treatment and to educate and address clinical necessity concerns and ABA (applied behavior analysis) compliance requirements.

• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.

• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

• Ensures appropriate and accurate information is entered into the claims system for processing of payment.

Education:

• MLD - Master's Level Degree REQUIRED

Certification/Licensure:

• Board Certified Behavior Analyst (BCBA) in Virginia REQUIRED

Experience:

• Knowledge of managed care contracting, medical necessity, Mental Health Services (MHS), behavioral health services, DMAS protocols, clinical protocols, and clinical review requirements REQUIRED

• Knowledge of contractual, regulatory and compliance requirements for government payers, self-funded and commercial payers REQUIRED

• ABA (applied behavior analysis)  with ASD (autism spectrum disorder) experience REQUIRED

• Health Plan experience preferred

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. 

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-77523

Talroo- Health Plan

Remote, VA, Virginia, Healthcare, Health Plan, MCO, Managed Care, Behavioral Health, Mental, Psych, BH, Utilization Management, UM, ABA, Applied behavior analysis, ASD, autism spectrum disorder, Mental Health Services, MHS, DMAS

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.