Remote Behavioral Health Utilization Review Clinician

Centene; California; Hybrid; CAD 53,000 - 95,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K stock plans

Tuition reimbursement

Paid time off

Flexible remote/hybrid/work schedules

Job summary

Centene is seeking a remote Health Care Reviewer focused on mental health and substance use to assess care and ensure medical appropriateness of services. The role supports the California market with flexible scheduling and requires nursing or related credentials plus BH utilization review experience.

Responsibilities include prior authorization, concurrent BH reviews, data analysis to improve utilization, and education for providers, members, and families. Licensure in BH fields is preferred.

Qualifications

• Requires nursing degree or bachelor's degree with 2-4 years of related experience.
• State licensure to practice independently is required.
• Master’s degree is required for behavioral health clinicians.
• Licensure in BH fields (LCSW/LMHC/LPC/LMFT/LMHP) is preferred.

Responsibilities

• Evaluates mental health and substance abuse treatment for medical appropriateness.
• Performs prior authorization reviews for BH services.
• Conducts concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve quality and utilization.
• Educates providers, members, and families on BH utilization.
• Interacts with BH providers and medical directors to improve care quality.

Skills

Clinical knowledge

Education

Bachelor's degree

Master's degree for behavioral health clinicians

RN license

State licensure required

LCSW / LMHC / LPC / LMFT / LMHP licenses

Job description

Centene is seeking a remote Health Care Reviewer focused on mental health and substance use to assess care and ensure medical appropriateness of services. The role supports the California market with flexible scheduling and requires nursing or related credentials plus BH utilization review experience.

Responsibilities include prior authorization, concurrent BH reviews, data analysis to improve utilization, and education for providers, members, and families. Licensure in BH fields is preferred.