Behavioral Health Care Coordinator - Whole Person Care- Hybrid!

Position Summary
City/State: Richmond, VA

Work Shift: First (Days)

Position Status: Full‑time, Permanent (40 hours/week)

Position Location: Hybrid based in Central Virginia (Fredericksburg, Petersburg, Richmond, Henrico, and nearby areas). Includes travel of approximately 2 days per week in the community (home, CSB, or hospital visits as needed) and 3 days working from home.

Standard Working Hours: 8 AM to 5 PM EST, Monday to Friday.

Overview
Sentara Health Plans is hiring for a Behavioral Health Utilization Management Care Coordinator – Whole Person Care – Hybrid in Central Virginia.

Responsibilities
The Behavioral Health Utilization Management Care Coordinator is responsible for reviewing clinical information received from providers, ensuring that clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed. Requires knowledge of managed care contracting, medical necessity, CMHRS services, BH and ARTS services, DMAS protocols, clinical protocols and clinical review requirements. Requires knowledge of contractual, regulatory and compliance requirements for government payers, self‑funded and commercial payers. Ensures appropriate and accurate information is entered into the claims system for payment processing.

Education

Master's degree in Counseling, Social Work, or Marriage and Family Therapy.

Registered Nurses: Bachelor of Science in nursing.

Certification / Licensure

Licensed Clinical Social Worker (LCSW) – State license (Virginia or North Carolina).

Licensed Professional Counselor (LPC) – State license (Virginia or North Carolina).

Licensed Marriage and Family Therapist (LMFT) – State license (Virginia or North Carolina).

Registered Nurse (RN) – Single State or Multi State nursing license (Virginia or North Carolina).

Experience

2 years of behavioral health experience (required).

1 year of case management experience (required).

Company Overview
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, 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.

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

401(k)/403(b) with Employer Match

Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education

Student Debt Pay Down – $10,000

Reimbursement for certifications and free access to complete CEUs and professional development

Pet Insurance

Legal Resources Plan

Equal Opportunity
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its workforce.

How to Apply
To apply, visit www.sentaracareers.com and use the keyword search: JR-88584.

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