Centene is seeking a Utilization Review Clinician - Behavioral Health to perform clinical review and assess care related to mental health and substance abuse. In this role, you will monitor and determine if the level of care and services are medically appropriate for our members.
What You'll Do
- Evaluate member's treatment for mental health and substance abuse before, during, and after services to ensure medical appropriateness.
- Perform prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with guidelines.
- Perform concurrent review of behavioral health inpatient cases to determine overall health, treatment needs, and discharge planning.
- Analyze behavioral health member data to improve quality and appropriate utilization of services.
- Provide education to providers, members, and their families regarding the behavioral health utilization process.
- Interact with behavioral health healthcare providers to discuss level of care and/or services.
- Engage with medical directors and leadership to improve the quality and efficiency of care.
- Formulate and present cases in staffing and integrated rounds.
What We're Looking For
- Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.
- Master’s degree for behavioral health clinicians.
- LCSW, LMHC, LPC, LMFT, LMHP, or RN with TX State Licensure and/or Compact State Licensure.
Nice to Have
- Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse.
- Knowledge of mental health and substance abuse utilization review process.
- Experience working with providers and healthcare teams to review care services related to mental health and substance abuse.
Benefits & Compensation
- Compensation: $27.02 - $48.55 per hour.
- Health insurance.
- 401K and stock purchase plans.
- Tuition reimbursement.
- Paid time off plus holidays.
- Flexible approach to work with remote, hybrid, field or office work schedules.
Work Mode
This is a remote position.
Centene is an equal opportunity employer.
