[Hiring] Board Certified Behavior Analyst (BCBA) @Sentara Health

Role Description

Sentara Health is hiring for a Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management- Remote in VA!

• Full-Time, permanent position (40 hours)
• Standard working hours: 8am to 5pm EST, M-F
• Location: Remote in Virginia only

The 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.

• 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 to educate and address clinical necessity concerns and ABA 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.

Qualifications

• MLD - Master's Level Degree (REQUIRED)
• Board Certified Behavior Analyst (BCBA) (REQUIRED)
• Licensed Behavioral Analyst in Virginia (LBA) (REQUIRED)

Requirements

• 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)

Benefits

• 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.