Remote Behavioral Health Utilization Review Clinician

IntelliResume; Louisiana (MO); On-site; USD 37,000 - 68,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Holidays

Flexible schedules

Job summary

Centene is seeking an Inpatient Utilization Review Clinician for Behavioral Health to perform clinical reviews and assessments ensuring appropriate care for members. This role emphasizes behavioral health utilization review with emphasis on the coordination of care across providers.

The position offers remote flexibility with a 8am–5pm schedule on days (Tuesday-Saturday or Wednesday-Sunday) and holiday rotation, supporting a comprehensive benefits package and ongoing education opportunities.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree required.
• Master’s degree for behavioral health clinicians required.

Responsibilities

• Evaluate member’s treatment for mental health and substance abuse to ensure medical appropriateness.
• Perform prior authorization reviews for mental health and substance abuse services.
• Conduct concurrent reviews of behavioral health inpatient cases.
• Analyze behavioral health member data to improve service utilization.
• Provide education to providers, members, and families regarding behavioral health utilization processes.
• Interact with behavioral health healthcare providers to discuss levels of care.
• Engage with medical directors and leadership to enhance care quality and efficiency.
• Formulate and present cases in staffing and integrated rounds.

Skills

Behavioral health

Utilization review

Healthcare compliance

Education

Bachelor's degree

Master's degree

Job description

Centene is seeking an Inpatient Utilization Review Clinician for Behavioral Health to perform clinical reviews and assessments ensuring appropriate care for members. This role emphasizes behavioral health utilization review with emphasis on the coordination of care across providers.

The position offers remote flexibility with a 8am–5pm schedule on days (Tuesday-Saturday or Wednesday-Sunday) and holiday rotation, supporting a comprehensive benefits package and ongoing education opportunities.