Utilization Review Clinician - Behavioral Health
About The Position
Centene is seeking a Utilization Review Clinician - Behavioral Health to join their Medical Management/Health Services team. This role is crucial for assessing care related to mental health and substance abuse for their members, ensuring that the level of care and services provided are medically appropriate. The clinician will perform reviews before, during, and after services, including prior authorization and concurrent reviews for behavioral health inpatient cases. The position involves analyzing member data to improve quality and utilization, educating providers and members, and collaborating with medical directors and leadership to enhance care efficiency. The role also requires presenting cases in staffing and integrated rounds.
Requirements
- Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.
- License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
- Master’s degree for behavioral health clinicians required.
- LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Nice To Haves
- 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.
Responsibilities
- Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate
- Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
- Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning
- Analyzes BH member data to improve quality and appropriate utilization of services
- Provides education to providers members and their families regrading BH utilization process
- Interacts with BH healthcare providers as appropriate 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.
- Complies with all policies and standards.
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off
- holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
