Behavioral Health Utilization Management Clinician, LCSW, LPC, LMFT, RN

Sentara Health

Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN for Substance Abuse at Sentara Health. Review clinical information to authorize services ensuring compliance with medical necessity criteria.

Posted 7/21/2026full-timeRemote • North Carolina, Virginia • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical necessity criteria for behavioral health and substance use services, ensuring compliance with regulatory and contractual requirements. Proficient in clinical review processes and claims management within the healthcare sector.

Highest-signal resume keywords

Master's Degree In CounselingLicensed Clinical Social Worker (LCSW)Licensed Professional Counselor (LPC)Licensed Marriage And Family Therapist (LMFT)2 Years Of Behavioral Health Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewMedical Necessity CriteriaClaims ProcessingUtilization ManagementSubstance Abuse Treatment

Certifications & Qualifications

State License - Virginia Department Of Health ProfessionalsState License - North Carolina Board Of Nursing

Industry Keywords

Behavioral HealthSubstance Use ServicesDMAS ProtocolsRegulatory ComplianceGovernment Payers

About the role

Key responsibilities & impact

Review clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed
Requires knowledge of medical necessity criteria for behavioral health and substance use 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 claims system for processing of payment.

Requirements

What you’ll need

Master's degree in Counseling, Social Work, or Marriage and Family Therapy REQUIRED
For Registered Nurses, a Bachelor of Science in nursing is REQUIRED
Certification/Licensure REQUIRED license must be valid in state of practice.
One of the following qualifies: Licensed Clinical Social Worker (LCSW) - State license - Virginia Department of Health Professionals (VADHP)
OR Licensed Clinical Social Worker (LCSW) - State license - North Carolina Social Work Certification and Licensure Board (NCSWCLB)
OR Licensed Professional Counselor (LPC) - State license - Virginia Department of Health Professionals (VADHP)
OR Licensed Professional Counselor (LPC) - State license - North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC)
OR Licensed Marriage and Family Therapist (LMFT) - State license - Virginia Department of Health Professionals (VADHP)
OR Licensed Marriage and Family Therapist (LMFT) - State license - North Carolina Marriage and Family Therapy Licensure Board (NCBMFT)
OR Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP)
OR Registered Nurse (RN) Single State - Nursing License - North Carolina Board of Nursing (NCBON)
OR Registered Nurse (RN) Multi State - Nursing License - Virginia Department of Health Professionals (VADHP)
OR Registered Nurse (RN) Multi State - Nursing License - North Carolina Board of Nursing (NCBON)
Licensed Substance Abuse Treatment Practitioner (LSATP) OR Certified Substance Abuse Counselor (CSAC) OR Licensed Chemical Dependency Counselors (LCDC) preferred
2 years of behavioral health REQUIRED
1 year of case management REQUIRED
Experience in substance abuse in American Society of Addiction Medicine (ASAM) levels of care) and utilization management preferred

Benefits

Comp & perks

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
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.