Utilization Review Clinician - Behavioral Health

Centene

263d • $26 - $47

About The Position

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. This is a remote position, and candidates must work in CST or EST time zones. The position requires 2-4 years of related experience. The role focuses on Utilization Management, with a strong preference for candidates with behavioral and substance abuse experience. The position involves performing clinical reviews and assessing care related to mental health and substance abuse, monitoring and determining the appropriateness of care levels and services, and evaluating member treatment throughout the care process. Responsibilities also include conducting prior authorization reviews, concurrent reviews of behavioral health inpatient cases, analyzing member data, providing education to stakeholders, and engaging with healthcare providers and leadership to improve care quality and efficiency.

Requirements

• Graduate of an Accredited School of Nursing or Bachelor's degree.
• 2 - 4 years of related experience.
• License to practice independently, and/or state required licensure.
• Master's degree for behavioral health clinicians required.
• Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred.
• Knowledge of mental health and substance abuse utilization review process preferred.
• Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.

Nice To Haves

• LCSW - License Clinical Social Worker required.
• LMHC - Licensed Mental Health Counselor required.
• LPC - Licensed Professional Counselor required.
• Licensed Marital and Family Therapist (LMFT) required.
• Licensed Mental Health Professional (LMHP) required.
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.

Responsibilities

• Performs a clinical review and assesses care related to mental health and substance abuse.
• Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate.
• Evaluates member's treatment for mental health and substance abuse before, during, and after services.
• Performs prior authorization reviews related to mental health and substance abuse.
• Performs concurrent review of behavioral health inpatient to determine overall health of member, treatment needs, and discharge planning.
• Analyzes behavioral health member data to improve quality and appropriate utilization of services.
• Provides education to providers, members, and their families regarding behavioral health utilization process.
• Interacts with behavioral health healthcare providers to discuss level of care and/or services.
• Engages with medical directors and leadership to improve the quality and efficiency of care.
• Formulates and presents cases in staffing and integrated rounds.
• Performs other duties as assigned.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree