Remote Behavioral Health Utilization Review Clinician

Centene Corporation; Louisiana (MO); Hybrid; USD 39,000 - 68,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules (remote/hybrid

Job summary

Centene Corporation is seeking a Behavioral Health Utilization Review clinician to evaluate and authorize BH services, ensure appropriate levels of care, and collaborate with providers and medical leadership. This role emphasizes quality improvement, case presentations, and compliance with regulatory guidelines.

Qualified candidates will have nursing or related clinical credentials, relevant licensure, and 2–4 years of BH review experience.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree with 2–4 years of related experience.
• State licensure to practice independently; applicable licensure per state.
• Master’s degree for behavioral health clinicians required.
• Clinical knowledge to review treatment plans for mental health & substance abuse.

Responsibilities

• Evaluate BH/substance abuse treatment to ensure medical appropriateness.
• Perform prior authorization reviews for BH services.
• Conduct concurrent BH inpatient reviews for discharge planning.
• Analyze BH member data to improve utilization.
• Educate providers, members, and families on BH processes.
• Interact with BH providers about level of care.
• Engage with medical directors to improve care quality.
• Present cases in staffing and rounds.
• Perform other duties as assigned.
• Comply with policies and standards.

Skills

Behavioral health

Utilization review

Prior authorization

Clinical review

Provider education

Team collaboration

Education

Graduate of an Accredited School of Nursing

Bachelor's degree

Master’s degree in Behavioral Health

Job description

Centene Corporation is seeking a Behavioral Health Utilization Review clinician to evaluate and authorize BH services, ensure appropriate levels of care, and collaborate with providers and medical leadership. This role emphasizes quality improvement, case presentations, and compliance with regulatory guidelines.

Qualified candidates will have nursing or related clinical credentials, relevant licensure, and 2–4 years of BH review experience.