• Manager, Behavioral Health-Utilization Review

    Job Locations US-VA-Glen Allen
    Job ID
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
    If this sounds like you, read on!


    The Manager of Behavioral Health will assist in initiatives to integrate behavioral health services into Virginia Premier’s Complete Care programs. S/he implements, manages and monitors contractual relationships with entities providing behavioral health services to Virginia Premier (VPHP) Complete Care (CCC) members. S/he coordinates activities between VPHP CCC staff, contracted providers, and health networks by providing guidance and decision support when appropriate. The position represents VPHP CCC and interacts with contracted organizations and providers, health networks, and other stakeholders in a manner that promotes collaborative working relationships. The Manager undertakes special projects in conjunction with the AVP of Duals Health Services, as assigned.


    • Act as a liaison with behavioral health contracted entities for day-to-day operations.
    • Coordinate between contracted entities and departments for problem resolution, process improvement and service integration.
    • Monitor and address contractor performance in meeting program requirements and recommend solutions.
    • Develop internal processes to monitor effectiveness of existing contracts and contracted entities.  Recommend strategies to enhance existing networks as identified.
    • Build, maintain, and enhance relationships with providers, health networks, community-based organizations, and other key stakeholders.
    • Promote and measure improvements in health outcomes for individuals receiving behavioral health services.
    • Assist with the community outreach and education, both provider and member, through coordination and collaboration with other departments.
    • Monitor compliance with federal, state and county contracts, Model of Care and/or MOUs, and other requirements set forth by regulatory agencies or funding sources specific to behavioral health care services.
    • Act as a liaison to community based and governmental providers that serve members.
    • Help develop, implement and, enhance effective processes to integrate behavioral health into VPHP CCC’s care delivery system.
    • Develop and champion innovative solutions to optimize programs for vulnerable populations.
    • Create and seize opportunities for innovative new program development for integrating behavioral health services.
    • Create and maintain effective working relationships both internally and with community based organizations, other governmental agencies, and with the population being served.
    • Effectively utilize computer and appropriate software and interact as needed with VPHP’s Information Systems.
    • Practices in accordance with applicable local, state and federal laws which govern confidentiality and medical information privacy regulations (HIPAA)
    • Other projects and duties as assigned.



    • Master's degree in Social Work, Marriage and Family Therapy or Public Health.
    • RN or LCSW licensed to practice in the Commonwealth of Virginia  


    • Work in a team environment, be flexible, and adapt to change.
    • Manage multiple deadlines in a fast-paced environment.
    • Work collaboratively with a wide variety of stakeholders.
    • Communicate effectively, both verbally and in writing, with individuals from varying cultural backgrounds. 
    • Ability to work with all levels of staff to identify issues and problem solve.
    • Have exceptional initiative and follow-through on projects with minimal supervision or guidance.
    • Managed care, Medicare, and Medicaid, with some experience in applying the appropriate regulations and guidelines to behavioral health care services.
    • Cultural needs for serving a socially and ethnically diverse population.
    • The specific and unique needs of individuals with mental illness and substance use disorders, and of the available resources in Virginia to meet these needs.  


    • 3 – 5 years’ experience managing the behavioral health benefit for members covered by Medicare, Medicaid or underserved populations.
    • Experience in a government or public environment preferred.
    • Experience in new program development for vulnerable populations, including strategic planning for a start-up program and implementing the program preferred.


    • Physical health sufficient to meet the ergonomic standards and demands of the position


    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE


    Our mission is to inspire healthy living within the communities we serve!


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