Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management

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) REQUIRED

• Licensed Behavioral Analyst in Virginia (LBA) 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

• 3 years of related experience REQUIRED

Keywords: 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, Licensed Behavioral Analyst, LBA, BCBA

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 •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.