Manager, Behavioral Health Care Management (RN/LCSW/LPC/LCAS) - Remote in VA

City/State

Work Shift

Overview:

Job Description 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.

• Manages approx 2 Team Coordinators

Education:

• ALD - Associate's Level Degree, MLD - Master's Level Degree, BLD - Bachelor's Level Degree, N-3YR - RN-Diploma (Non-degree) preferred

Certification/Licensure:

• Registered Nurse License (RN) - Nursing License in Virginia OR Compact/Multi-State License, Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW) OR Clinical Addiction Specialist (CAS) REQUIRED

Experience:

• Medicare- 3 years experience REQUIRED

• Behavioral Health- 3 years experience REQUIRED

• Healthcare Management- 3 years experience REQUIRED

• Medicaid- 3 years experience REQUIRED

• Experience with NCQA Managed Behavioral Healthcare Organizations (MBHO) 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.

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 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-77152

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Talroo-Health Plan

Behavioral Health, Care Coordinator, Case Management, Social Work, Nursing, Human Services, Registered Nurse, RN, Licensed Professional Counselor, LPC, Licensed Clinical Social Worker (LCSW), Clinical Addiction Specialist (CAS), Remote, VA, Virginia, Medical Group, Clinic, Healthcare, Health Plan, MCO, Managed Care

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.