Utilization Review Clinician - Behavioral Health
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. NOTE: NOTE: This is a fully remote completing reviews for Youth-In-Care or Former Youth-In-Care members, ages 0-21 receiving inpatient and outpatient behavioral health services. Preference will be given to applicants who (1) reside in the state of Illinois, are (2) licensed in Illinois, and have a combination of (3) experience in various mental health settings especially inpatient behavioral health units, utilization management / review, and youth or pediatric services. Additional Details: • Department: Illinois Utilization Management • Business Unit: Illinois Health Plan • Schedule: Monday through Friday 8-4:30 pm CT • Caseload: DCFS Youth in Care /Former Youth in Care under 21 yrs of age. Position Purpose: 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 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.
Requirements
- Requires 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 and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
