Remote Hybrid Manager, Behavioral Health Care Management – Mutliple States

Sentara

Apply Now

Virginia Premier Health Plan Glen Allen
Full time
Posted Today
JR-43203

City/State

Glen Allen, VA

 

 

Overview

 

Work Shift

First (Days) (United States of America)

 

 

Sentara Health Plans is hiring a Manager, Behavioral Health Care Management!

 

This is a Full Time position with Day shift hours and great benefits!

 

Remote opportunities are available in the following states:

Alabama, Delaware, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming

 

Required Qualifications:

  • Licensed Clinical Addiction Specialist (CAS) -or- Licensed Clinical Social Worker (LCSW) -or- Licensed Professional Counselor (LPC) -or- Registered Nurse, BSN -or- Clinical Psychologist
  • Minimum 3 years experience in Behavioral Health
  • Minimum 3 years experience in Healthcare Management
  • Minimum 3 years experience with Medicaid and Medicare
  • Minimum 3 years experience in Managed Care
  • Minimum 3 years Utilization Management experience

 

Primary responsibilities include:

  • Responsible for the leadership of behavioral health and addiction recovery treatment teams in the health plan
  • Oversees daily operations including coordination of work, quality, and service for Licensed and Non-Licensed Behavioral Health Utilization Review and Care Coordination staff
  • Ensures member progression through the care continuum in a manner that achieves designated clinical and financial outcomes
  • Monitors member utilization of behavioral health services using claims analysis, quality outcome indicators and reporting capabilities
  • Provides oversight of management and auditing of assessments, treatment and post-discharge plans
  • Monitors and guides staff competency development, staffing resource planning, onboarding and engagement initiatives across teams
  • Stays abreast of NCQA, DMAS, and CMS policies and standards and oversees compliance with policies, programs, and service delivery
  • Partners with the Health Plan Quality team to maximize HEDIS, CAHPS, and STARS ratings which integrate behavioral health services
  • Oversees root cause analysis and associated actions to improve clinical outcomes.

 

 

Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.

 

With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, 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.

 

As the third-largest employer in Virginia, Sentara Healthcare was named by Forbes Magazine as one of America’s best large employers.  We offer a variety of amenities to our employees, including, but not limited to: 

  • Medical, Dental, and Vision Insurance
  • Paid Annual Leave, Sick Leave
  • Flexible Spending Accounts
  • Retirement funds with matching contribution
  • Supplemental insurance policies, including legal, Life Insurance and AD&D among others
  • Work Perks program including discounted movie and theme park tickets among other great deals
  • Opportunities for further advancement within our organization

 

Sentara employees strive to make our communities healthier places to live.  We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace.  For information about our employee benefits, please visit: Benefits – Sentara (sentaracareers.com)

 

 

Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!

 

Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family’s well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental, and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time, and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if the established system and employee eligibility criteria are met.

For applicants within Washington State, the following hiring range will be applied: $105,836.64(annually) to $146,044.08(annually).

 

 

Keywords: Managed Care, Utilization Management, MCO, Behavioral Health Utilization Review, CAS, LCSW, LPC, RN

 

 

Job Summary

 

Responsible for the leadership of behavioral health and addiction recovery treatment teams in the health plan. Oversees daily operations including coordination of work, quality, and service for Licensed and Non-Licensed Behavioral Health Utilization Review and Care Coordination staff. Ensures member progression through the care continuum in a manner that achieves designated clinical and financial outcomes. Monitors member utilization of behavioral health services using claims analysis, quality outcome indicators and reporting capabilities. Provides oversight of management and auditing of assessments, treatment and post-discharge plans. Monitors and guides staff competency development, staffing resource planning, onboarding and engagement initiatives across teams. Stays abreast of NCQA, DMAS, and CMS policies and standards and oversees compliance with policies, programs, and service delivery. Partners with the Health Plan Quality team to maximize HEDIS, CAHPS, and STARS ratings which integrate behavioral health services. Oversees root cause analysis and associated actions to improve clinical outcomes.

Bachelor’s Degree in Social Work (LCSW), Clinical Psychologist, Nursing, Licensed Clinical Addiction Specialist (LCAS), Professional Counseling (LPC) or related field required. Master’s Degree preferred.
Proven ability to drive clinical teams toward a culture of compliance, strategic and organizational agility, and mastery of engaging and developing staff policies.
Knowledge and experience with best practices applicable to behavioral health and care management.
Extensive knowledge of regulatory requirements and policy coverage guidance applicable to Medicaid and Medicare utilization management.

 

 

Qualifications:

 

BLD – Bachelor’s Level Degree (Required), MLD – Master’s Level Degree

 

Behavioral Health, Healthcare Management, Medicaid, Medicare

 

Skills

 

Active Learning, Active Learning, Active Listening, Communication, Complex Problem Solving, Coordination, Critical Thinking, Judgment and Decision Making, Leadership, Learning Strategies, Mathematics, Mgmt of Financial Resources, Mgmt of Material Resources, Mgmt of Staff Resources, Microsoft Excel, Microsoft Word, Monitoring, Persuasion, Project Management, Quality Control Analysis, Reading Comprehension, Science, Service Orientation, Social Perceptiveness, Speaking {+ 5 more}

 

 

Sentara Healthcare 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.

 

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission “to improve health every day,” this is a tobacco-free environment.