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Award-winning: Sentara is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!
Sentara Health Plans is recruiting Manager, Behavioral Health Care Management (RN/LCSW/LPC/LCAS)- 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 Description Summary:
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Responsible for the leadership of behavioral health and addiction recovery treatment teams in the health plan.
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Oversees daily operations including coordination of work, quality, and service for Licensed and Non-Licensed Behavioral Health Utilization Review and Care Coordination staff.
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Ensures member progression through the care continuum in a manner that achieves designated clinical and financial outcomes.
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Monitors member utilization of behavioral health services using claims analysis, quality outcome indicators and reporting capabilities.
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Provides oversight of management and auditing of assessments, treatment and post-discharge plans.
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Monitors and guides staff competency development, staffing resource planning, onboarding and engagement initiatives across teams.
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Stays abreast of NCQA, DMAS, and CMS policies and standards and oversees compliance with policies, programs, and service delivery.
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Partners with the Health Plan Quality team to maximize HEDIS, CAHPS, and STARS ratings which integrate behavioral health services.
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Oversees root cause analysis and associated actions to improve clinical outcomes.
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Manages approx 2 Team Coordinators
Education:
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ALD – Associate's Level Degree, MLD – Master's Level Degree, BLD – Bachelor's Level Degree, N-3YR – RN-Diploma (Non-degree) preferred
Certification/Licensure:
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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:
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Medicare- 3 years experience REQUIRED
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Behavioral Health- 3 years experience REQUIRED
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Healthcare Management- 3 years experience REQUIRED
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Medicaid- 3 years experience REQUIRED
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Experience with NCQA Managed Behavioral Healthcare Organizations (MBHO) preferred
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Proven ability to drive clinical teams toward a culture of compliance, strategic and organizational agility, and mastery of engaging and developing staff policies.
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Knowledge and experience with best practices applicable to behavioral health and care management.
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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 quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
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.
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
When you join Sentara in a clinical role, you become part of an interdisciplinary team that is passionate about quality care. Our diverse inpatient and outpatient settings offer the tools and technologies you need to do your best work. All while learning and growing within a culture that embraces opportunity.
Culture In Action
At Sentara, our differences are our strengths. The unique backgrounds, skills, and experiences that each Sentara colleague brings to work are what make Sentara special and what allows us to deliver excellent service and care to our patients, members, and communities.
Sentara 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.
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