Behavioral Health Utilization Review Clinician (Remote Options)

Centene Corporation; Louisiana; Remote; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a clinical reviewer to evaluate mental health and substance use treatment, ensuring appropriate level of care and timely services. The role involves prior authorization and concurrent review of behavioral health cases, with collaboration across medical directors and providers.

The candidate should hold a Master's degree in a related field and an independent licensure (TX). Experience with Medicaid or government programs and 4+ years auditing medical necessity is

Qualifications

• Requires a Master’s degree in Mental Health, Counseling, or Social Work.
• License to practice independently with state licensure (TX) is required.
• Clinical knowledge to review treatment plans for mental health and substance abuse preferred.
• Experience with Medicaid or government-sponsored programs preferred.
• 4+ years auditing medical necessity reviews for LOCs (0–65).
• 2+ years collaborating with Medicaid or Community Mental Health providers.

Responsibilities

• Evaluates member's treatment for mental health and substance abuse to ensure medical appropriateness.
• Performs prior authorization reviews for mental health/substance abuse.
• Conducts concurrent review of BH inpatient care and discharge planning.
• Analyzes BH data to improve utilization of services.
• Provides education to providers, members, and families about BH utilization processes.
• Interacts with BH providers and medical directors to improve care quality.

Education

Master's degree in Mental Health/Counseling/Social Work

Texas licensure (LCSW/LMHC/LPC/LMFT/RN)

Job description

Centene Corporation is seeking a clinical reviewer to evaluate mental health and substance use treatment, ensuring appropriate level of care and timely services. The role involves prior authorization and concurrent review of behavioral health cases, with collaboration across medical directors and providers.

The candidate should hold a Master's degree in a related field and an independent licensure (TX). Experience with Medicaid or government programs and 4+ years auditing medical necessity is