Utilization Review Clinician - Behavioral Health
About The Position
Performs clinical documentation reviews and assesses care related to mental health and substance abuse. Monitors and determines whether levels of care and related services are medically appropriate. The role reviews treatment before, during, and after services, and works with providers, members, families, medical directors, and leadership to support appropriate behavioral health care and utilization. Candidates must have one of the listed independent clinical licenses issued by Texas. Consideration is given to LPC, LCSW, LMFT, or LMHC clinicians, and RNs with direct psychiatric IOP, managed-care behavioral health utilization management or review, or behavioral health care management experience. Candidates with experience auditing and reviewing behavioral health intake assessments, treatment plans, and services related to mental health and substance abuse are sought. The required schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. CST; some holidays may also be required. The stated pay range is $27.02 to $48.55 per hour. Centene describes its work as supporting access to healthcare and improving the lives of individuals, families, and communities. It offers a comprehensive benefits package and a flexible approach to work with remote, hybrid, field, or office schedules. Actual pay may vary based on skills, experience, education, job-related factors, and full-time or part-time status. Total compensation may include incentives, and benefits may be subject to eligibility.
Requirements
- Master’s degree related to mental health, counseling, or social work; alternatively, graduation from an accredited school of nursing.
- Two to four years of related behavioral health or psychiatric experience.
- License to practice independently and required state licensure, issued by Texas for the listed licenses.
- One of the following licenses: LCSW, LMHC, LPC, LMFT, or RN state licensure and/or compact state licensure.
- Experience working with mental health providers and behavioral health healthcare teams.
Nice To Haves
- Clinical knowledge and ability to review or assess treatment plans related to mental health and substance abuse.
- Knowledge of mental health and substance abuse utilization review processes.
- Four or more years auditing medical necessity reviews and assessing levels of care for adults and children ages 0–65.
- Two or more years working and collaborating with Medicaid providers or Community Mental Health providers.
- Experience with state and government-sponsored programs such as Medicaid, Medicare, or Marketplace Commercial insurance.
- Direct psychiatric IOP, managed-care behavioral health utilization management or utilization review, or behavioral health care management experience.
- Experience auditing and reviewing behavioral health intake assessments, treatment plans, and healthcare services related to mental health and substance abuse.
Responsibilities
- Evaluate members’ mental health and substance abuse treatment before, during, and after services to ensure levels of care and services are medically appropriate.
- Perform prior authorization reviews for mental health and substance abuse services, determining medical appropriateness in accordance with regulatory guidelines and criteria.
- Perform concurrent reviews of behavioral health inpatient care to determine members’ overall health, treatment needs, and discharge planning.
- Analyze behavioral health member data to improve quality and appropriate utilization of services.
- Educate providers, members, and their families about behavioral health utilization processes.
- Interact with behavioral health providers as appropriate to discuss levels of care and services.
- Work with medical directors and leadership to improve the quality and efficiency of care.
- Formulate and present cases in staffing and integrated rounds.
- Perform other duties as assigned.
- Comply with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401(k) and stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible approach to work schedules, including remote, hybrid, field, or office work
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
