City/State: Norfolk, VA Work Shift: Weekend Days Overview: Join Sentara Health Plans as a Behavioral Health Utilization Management Care Coordinator (LCSW/LPC/LMFT/RN) from the comfort of your home in Virginia or Northeast North Carolina! This is a full-time, permanent position totaling 40 hours per week. Enjoy flexible day shifts, with start times ranging from 6 AM to 9 AM EST, running a 4×10 schedule from Thursday to Sunday. Job Summary: – In this role, you will serve as a Behavioral Health Utilization Management clinician, tasked with reviewing clinical information submitted by providers. Your expertise will help ensure that the clinical data meets the Medical Necessity Criteria to authorize necessary services effectively. – You will need to possess a solid understanding of medical necessity standards for both behavioral health and substance use services, familiarity with DMAS protocols, clinical protocols, and clinical review requirements. – Knowledge of compliance, regulatory, and contractual requirements related to government payers, self-funded, and commercial payers is essential for this role. – You’ll be responsible for accurately entering appropriate information into the claims system to facilitate payment processing. Educational Requirements: – A Master’s Degree in Social Work or a Counseling-related field is required, or a Bachelor’s Degree in Nursing. Certification/Licensure: – Candidates must have a current license as a Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or Registered Nurse (RN) in the state of Virginia. Experience Required: – A minimum of 2 years of clinical experience is required, alongside at least 2 years of experience in behavioral health—preferably including 1 year focused on behavioral health care coordination, discharge planning, continuity of care, or transitions of care. – Case management experience is a plus. Sentara Health Plans delivers comprehensive health coverage to nearly one million members across Virginia. We provide a wide range of commercial products, including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs, and support for Medicare and Medicaid enrollees. Our expansive provider network ensures access to specialists, primary care practitioners, and hospitals, bolstered by programs aimed at helping members manage chronic illnesses and wellness initiatives, alongside integrated clinical and behavioral health services to enhance our members’ health outcomes. At Sentara Health, we cultivate a friendly work environment that promotes community engagement and abundant opportunities for professional development. Join a healthcare organization that prioritizes its people, service quality, patient safety, and integrity. Help us fulfill our mission to improve health every day and realize our vision of becoming the preferred healthcare provider in our communities! To apply, visit us online and use Keyword Search: JR-81602 – Health PlanManaged Care, MCO, Health Plan, Healthcare, Masters, Social Work, Counseling Field, BSN, Nursing, Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Registered Nurse (RN), Clinical, behavioral health, care coordination, discharge planning, continuity of care, transitions of care, Remote, Virginia, Weekends, Days, North Carolina. Benefits: At Sentara, we care for your family and your career: – Comprehensive Medical, Dental, and Vision plans – Adoption, Fertility, and Surrogacy Reimbursement up to $10,000 – Generous Paid Time Off and Sick Leave policies – Paid Parental and Family Caregiver Leave – Emergency Backup Care services – Long-Term and Short-Term Disability, along with Critical Illness plans – Life Insurance coverage – 401k/403B plans with Employer Matching – Tuition Assistance of $5,250 annually and discounted education opportunities through Guild Education – Student Debt Pay Down Program – $10,000 Reimbursement for Certifications and complimentary access to CEUs and professional development resources – Pet Insurance and Legal Resources Plans Additionally, teammates may be eligible for an annual discretionary bonus based on performance criteria. Sentara Health is an equal opportunity employer, celebrating the diversity and inclusiveness within our nearly 30,000-member strong workforce. Embracing diversity, inclusion, and belonging guides our organizational principles to reflect the communities we serve. Our steadfast mission “to improve health every day” is part of a tobacco-free environment. For remote opportunities, Sentara Health employs team members across various states, including 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.