Utilization Review Clinician - Behavioral Health

Centene Corporation

1d • Remote

About The Position

Centene is seeking a Utilization Review Clinician for their Medical Management/Health Services team. This role is responsible for performing clinical reviews and assessments related to mental health and substance abuse care to ensure medical appropriateness. The position is fully remote, requiring candidates to be located in Oklahoma and hold an active Oklahoma license. The company offers a flexible approach to work and a comprehensive benefits package.

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.
• 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
• 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
• Number of Employees: 5,001-10,000 employees