City/State

Norfolk, VA

Work Shift

First (Days)

Overview:

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

Status: Full-Time, permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F.

Location: Remote in Virginia only

Job Profile Summary:

Board Certified Behavior Analyst (BCBA) Utilization Management Professional applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health, specific to Behavior Analysis. Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, applying evidence-based standards, and practice guidelines to treatment where appropriate.

Job Description:

• 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

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

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