Remote Behavioral Health Utilization Review Clinician
Centene
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Benefits offered by this job
Job summary
Centene is hiring a Utilization Review Clinician - Behavioral Health for a fully remote position, serving members nationwide with a focus on mental health and substance abuse utilization management. The role emphasizes clinical reviews, prior authorizations, and data-driven care improvement.
Requirements include a nursing or related degree, a Master\'s in behavioral health, and 2–4 years of relevant experience with licensure options such as LCSW/LMHC/LPC/LMFT/LMHP or RN.
Qualifications
- Bachelor's degree required; Master's degree in behavioral health required for clinicians.
- 2-4 years of related experience preferred.
- Licenses: LCSW, LMHC, LPC, LMFT, LMHP, or RN licensure required.
Responsibilities
- Evaluate mental health and substance abuse treatment for medical appropriateness.
- Perform prior authorization reviews for mental health and substance use services.
- Conduct concurrent reviews of behavioral health inpatient cases.
- Analyze behavioral health data to improve service utilization.
- Educate providers, members, and families on the utilization process.
- Collaborate with medical directors and leadership to improve care quality.
- Present cases in staffing and integrated rounds.
- Adhere to policies and standards.
Skills
Education
Job description
Centene is hiring a Utilization Review Clinician - Behavioral Health for a fully remote position, serving members nationwide with a focus on mental health and substance abuse utilization management. The role emphasizes clinical reviews, prior authorizations, and data-driven care improvement.
Requirements include a nursing or related degree, a Master\'s in behavioral health, and 2–4 years of relevant experience with licensure options such as LCSW/LMHC/LPC/LMFT/LMHP or RN.
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