Remote Behavioral Health Utilization Review Clinician

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

Benefits offered by this job

Health insurance

401K/Stock options

Tuition reimbursement

Paid time off & holidays

Job summary

Centene Corp. is seeking a licensed clinician to perform clinical reviews and assess mental health and substance use care for medical appropriateness.

The role supports the California market and is fully remote, with schedule options for CA residents and eligibility for non-CA applicants willing to accommodate training and core shifts. The candidate will evaluate treatment plans, perform prior authorization and concurrent BH reviews, and collaborate with providers and medical directors to ensure

Qualifications

• Graduate of an Accredited School Nursing or Bachelor's degree and 2–4 years of related experience.
• Master’s degree for behavioral health clinicians required.
• Clinical knowledge for reviewing mental health and substance abuse treatment plans.

Responsibilities

• Evaluates member’s mental health and substance abuse treatment for appropriateness.
• Performs prior authorization reviews for BH services.
• Conducts concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve utilization and quality.
• Educates providers, members, and families on BH utilization processes.
• Interacts with BH providers to discuss level of care and services.
• Collaborates with medical directors to improve care quality and efficiency.
• Presents cases in staffing and rounds.
• Performs additional duties per policy.

Skills

Clinical review

Utilization management

Care coordination

Provider education

Education

Accredited nursing program or Bachelor's degree

Master’s degree in behavioral health

Active clinical licensure (LCSW/LMHC/LPC/LMFT/LMHP/RN)

Job description

Centene Corp. is seeking a licensed clinician to perform clinical reviews and assess mental health and substance use care for medical appropriateness.

The role supports the California market and is fully remote, with schedule options for CA residents and eligibility for non-CA applicants willing to accommodate training and core shifts. The candidate will evaluate treatment plans, perform prior authorization and concurrent BH reviews, and collaborate with providers and medical directors to ensure