Remote Behavioral Health Utilization Review Clinician

Centene Corporation; California (MO); Hybrid; CAD 53,000 - 95,000; Full time

Benefits offered by this job

Remote work

Health insurance

401K and stock purchase plans

Job summary

Centene Corporation is seeking a remote Behavioral Health Utilization Review Nurse/Clinician to assess care for mental health and substance abuse. Role supports the California Market with flexibility for other states, working Mon-Fri Pacific time. Licensure as required and master’s in behavioral health preferred.

Primary duties include reviews before, during, and after services, education for providers, and collaboration with medical directors to ensure appropriate care and discharge planning.

Qualifications

• Graduate of an Accredited School Nursing or Bachelor's degree with 2–4 years related experience.
• State license to practice independently as applicable.
• Master’s degree for behavioral health clinicians required.
• Clinical knowledge to review/treat mental health and substance abuse plans preferred.

Responsibilities

• Evaluate treatment for mental health and substance abuse to ensure medically appropriate level of care.
• Perform prior authorization reviews for mental health/substance abuse per guidelines.
• Conduct concurrent BH inpatient review for discharge planning and needs.
• Analyze BH data to improve utilization and quality of care.
• Educate providers, members, and families on BH utilization processes.
• Collaborate with BH providers and medical leadership to improve care efficiency.

Skills

Behavioral health

Utilization review

Prior authorization

Clinical assessment

Education

Bachelor's degree in Nursing

Master’s degree in Behavioral Health

RN Licensure

Licensed Mental Health Professional

Job description

Centene Corporation is seeking a remote Behavioral Health Utilization Review Nurse/Clinician to assess care for mental health and substance abuse. Role supports the California Market with flexibility for other states, working Mon-Fri Pacific time. Licensure as required and master’s in behavioral health preferred.

Primary duties include reviews before, during, and after services, education for providers, and collaboration with medical directors to ensure appropriate care and discharge planning.