Remote Behavioral Health Utilization Review Clinician

Centene Management Company LLC; Arizona; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements

Job summary

Centene Management Company LLC is seeking a Behavioral Health Care Reviewer to perform clinical reviews of mental health and substance use services, ensuring appropriate levels of care and adherence to guidelines.

The role supports prior authorizations, concurrent BH inpatient reviews, and data-driven quality improvements across care teams, with a second shift (2pm–10pm EST) and flexible scheduling across time zones.

Qualifications

• Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2–4 years of related experience.
• License to practice independently and/or state required licensure as applicable.
• Master’s degree for behavioral health clinicians required.
• 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

• 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.
• Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness per guidelines.
• Performs concurrent review of behavioral health inpatient cases to determine health, needs, and discharge planning.
• Analyzes behavioral health member data to improve quality and utilization of services.
• Provides education to providers, members, and families regarding BH utilization process.
• Interacts with BH healthcare providers to discuss level of care and services.
• Engages with medical directors and leadership to improve 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.

Education

Bachelor's degree Nursing or related field

Master’s degree in Behavioral Health

Job description

Centene Management Company LLC is seeking a Behavioral Health Care Reviewer to perform clinical reviews of mental health and substance use services, ensuring appropriate levels of care and adherence to guidelines.

The role supports prior authorizations, concurrent BH inpatient reviews, and data-driven quality improvements across care teams, with a second shift (2pm–10pm EST) and flexible scheduling across time zones.