About this opportunity
Sentara Healthcare Inc lists this Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management opportunity in norfolk, Virginia. Review the employer’s description below for duties, qualifications and application requirements.
Job description
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
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Worksite address
norfolk, VA, 23500, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.