Remote Behavioral Health Utilization Review Clinician

Centene Management Company LLC; California (MO); Hybrid; USD 37,000 - 66,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote work options

Job summary

Centene Management Company LLC is seeking a remote clinical reviewer focused on mental health and substance use care to support the California Market, with a schedule of Monday through Friday, 9:00–18:00 or 9:30–18:00 Pacific Time, and occasional overtime. Applicants from other states may apply if they can align with Pacific Time.

The role requires nursing or bachelor's level education, 2–4 years of related experience, and licensure as applicable.

Qualifications

• Requires nursing degree or Bachelor's in a related field.
• 2–4 years of related clinical experience.
• License to practice independently per state requirements; multiple licenses listed.
• Master’s degree for behavioral health clinicians preferred.

Responsibilities

• Evaluates member’s treatment for mental health and substance use to ensure medically appropriate care.
• Performs prior authorization reviews for mental health and substance use.
• Performs concurrent BH inpatient reviews to assess health, needs, and discharge planning.
• Analyzes BH data to improve quality and utilization of services.
• Provides education to providers, members, and families on BH utilization processes.
• Interacts with BH providers and discusses level of care and services.
• Engages with medical directors to improve care quality and efficiency.
• Performs other duties as assigned.

Skills

Behavioral health utilization review

Regulatory guidelines knowledge

Prior authorization reviews

Education

Bachelor's degree in nursing

Master's degree in behavioral health

Job description

Centene Management Company LLC is seeking a remote clinical reviewer focused on mental health and substance use care to support the California Market, with a schedule of Monday through Friday, 9:00–18:00 or 9:30–18:00 Pacific Time, and occasional overtime. Applicants from other states may apply if they can align with Pacific Time.

The role requires nursing or bachelor's level education, 2–4 years of related experience, and licensure as applicable.