Remote Behavioral Health Utilization Review Clinician

Centene Corporation; Kentucky; Remote; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Remote/hybrid/office options

Job summary

Centene Corporation is seeking a remote Behavioral Health Utilization Review Specialist to assess care for mental health and substance use, reviewing authorization requests and inpatient cases across various settings. The role emphasizes collaboration with providers, medical directors, and care teams to ensure appropriate levels of care.

Qualified candidates typically hold nursing or behavioral health credentials and relevant licensure with 2–4 years of related experience.

Qualifications

• Requires RN/clinical licensure and behavioral health credentials.
• Experience reviewing mental health and substance use treatment plans.
• Knowledge of utilization review processes and regulatory guidelines.
• Prior experience with providers and healthcare teams.

Responsibilities

• Evaluates treatment for MH and SUD before, during, and after services.
• Performs prior authorization reviews to determine medical appropriateness.
• Performs concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve service utilization.
• Educates providers, members, and families on BH utilization.
• Interacts with BH providers to discuss level of care.
• Engages with medical directors to improve care quality and efficiency.
• Formulates and presents cases in staffing and rounds.
• Performs other duties as assigned and complies with policies.
• Meets licensure and regulatory requirements for role.

Skills

Clinical review

Prior authorization

BH utilization review

Education to providers

Collaboration with medical directors

Data interpretation

Education

Bachelor's degree

Master’s degree in behavioral health

Graduate of an Accredited School Nursing

LCSW

LMHC

LPC

LMFT

LMHP

RN State Licensure

Job description

Centene Corporation is seeking a remote Behavioral Health Utilization Review Specialist to assess care for mental health and substance use, reviewing authorization requests and inpatient cases across various settings. The role emphasizes collaboration with providers, medical directors, and care teams to ensure appropriate levels of care.

Qualified candidates typically hold nursing or behavioral health credentials and relevant licensure with 2–4 years of related experience.