Remote Behavioral Health Utilization Review Clinician

Centene Corporation; California City (CA); Remote; USD 37,000 - 67,000; Full time

Job summary

Centene Corporation is seeking a remote Behavioral Health/Utilization Review professional to support the California Market. The role requires nursing or bachelor’s degree with 2–4 years of related experience and appropriate behavioral health licensure.

The position offers a full-time schedule (Mon–Fri, Pacific time) with potential overtime and holidays. Strong knowledge of regulatory guidelines is preferred and prior authorization experience is valued.

Qualifications

• Requires nursing or bachelor’s degree with 2–4 years of related experience.
• Master’s degree in behavioral health preferred for clinicians.
• Licensure as specified (LCSW/LMHC/LPC/LMFT/LMHP/RN) required or obtained.

Responsibilities

• Performs clinical review and assesses care related to mental health and substance abuse.
• Performs prior authorization reviews for BH/SA to determine medical appropriateness.
• Performs concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve quality and utilization of services.
• Provides education to providers, members and families re BH utilization.
• Engages with medical directors to improve quality and efficiency of care.

Skills

Behavioral health utilization

Clinical review

Provider education

Regulatory guidelines

Education

Graduate of an Accredited School of Nursing or Bachelor's degree

Master's degree in behavioral health (preferred)

Job description

Centene Corporation is seeking a remote Behavioral Health/Utilization Review professional to support the California Market. The role requires nursing or bachelor’s degree with 2–4 years of related experience and appropriate behavioral health licensure.

The position offers a full-time schedule (Mon–Fri, Pacific time) with potential overtime and holidays. Strong knowledge of regulatory guidelines is preferred and prior authorization experience is valued.