Uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.
Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Must meet one of the following: Active unrestricted registered nurse license in the state of Virginia or obtain a multi-state license in a state that participates in the enhanced compact licensure, (eNLC) with Behavioral Health experience (ie. Inpatient psychiatric care, substance use treatment or other Behavioral Health treatment settings)
Active unrestricted LCSW, LPC, LMFT, or LCP, Licensed Clinical Psychologist to practice as a health professional within the state of Virginia
Minimum one, (1) year of post-degree clinical experience in private practice or other clinical patient care setting
Minimum one, (1) year of managed care experience
Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms
Ability to troubleshoot and resolve basic technical difficulties in a remote environment.
Ability to work independently under general instructions and with a team
Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills

Medical, dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance
Competitive benefits that support whole-person well-being

Utilization Management Behavioral Health Professional

Key skills