Centene Management Company LLC is hiring a Utilization Review Clinician - Behavioral Health to perform clinical assessment of mental health and substance abuse care. You will ensure services are medically appropriate and collaborate with providers to improve care quality and efficiency.
What You'll Do
- Evaluate treatment for mental health and substance abuse before, during, and after services to ensure medical appropriateness.
- Perform prior authorization and concurrent reviews for behavioral health inpatient care, following regulatory guidelines.
- Analyze member data to improve the quality and appropriate utilization of behavioral health services.
- Provide education to providers, members, and families regarding the utilization review process.
- Interact with healthcare providers to discuss levels of care and services.
- Engage with medical directors and leadership to improve care quality and efficiency.
- Formulate and present cases in staffing and integrated rounds.
What We're Looking For
- Graduate of an Accredited School of Nursing or Bachelor's degree with 2 – 4 years of related experience.
- OR Master's degree with 2 - 4 years of related behavioral health or substance abuse addiction disorders experience.
- License to practice independently with required state licensure.
- One of the following licenses: Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marital and Family Therapist (LMFT), or Licensed Mental Health Professional (LMHP).
Nice to Have
- Graduate of an Accredited Master’s degree in a Behavioral Health related field.
- Direct experience with Utilization Review or Utilization Management for Behavioral Health cases.
- Clinical knowledge to review and assess treatment plans for mental health and substance abuse.
- Experience working with providers to review care services, precertification, concurrent review, and discharge reviews.
- Direct IOP Behavioral Health and/or SUD inpatient hospital experience.
- Working knowledge and direct experience with the ASAM Criteria and levels of care for Addiction Treatment.
- Direct BH/SUD inpatient intake assessments experience.
- Direct work experience in Behavioral Health UR, UM, or CM in Managed Care Organizations, In-Patient Behavioral Health Units, Partial Hospitalization, or Residential Treatment.
Benefits & Compensation
- Compensation: $26.50 - $47.59 per hour
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field, or office schedules.
Work Mode
This position is remote.
Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
