Utilization Review Clinician - Behavioral Health

Centene Corporation

20h • Remote

About The Position

This is a fully remote position for a clinical professional on the Medical Management/Health Services team. The role involves performing clinical reviews and assessing care related to mental health and substance abuse to determine medical appropriateness. The position requires monitoring and evaluating member treatments, performing prior authorization reviews, and analyzing data to improve quality and utilization of services. The clinician will also provide education to providers, members, and families, interact with healthcare providers, and engage with medical directors and leadership. Case formulation and presentation in staffing and integrated rounds are also part of the role.

Requirements

• Graduate of an Accredited School Nursing or Bachelor's degree
• 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
• Candidates must be located in Oklahoma and hold an active Oklahoma license.

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 and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level