United States onlyCity/State
Norfolk, VAWork 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 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
We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is:$60,756.80-$101,254.40Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.Benefits: Caring For Your Family and Your Career• Medical, Dental, Vision plans• Adoption, Fertility and Surrogacy Reimbursement up to $10,000• Paid Time Off and Sick Leave• Paid Parental & Family Caregiver Leave • Emergency Backup Care• Long-Term, Short-Term Disability, and Critical Illness plans• Life Insurance• 401k/403B with Employer Match• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education• Student Debt Pay Down – $10,000• Reimbursement for certifications and free access to complete CEUs and professional development•Pet Insurance•Legal Resources Plan
•Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
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.
