Remote Behavioral Health Utilization Review Clinician

Centene Corporation; Missouri; Hybrid; USD 3,722,000 - 6,688,000; Full time

Benefits offered by this job

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a health services professional to perform clinical documentation reviews and assess care for mental health and substance use services. The role monitors level of care and ensures medical appropriateness across BH therapies.

The candidate should hold an MSW/related master’s degree and have state licensure (LCSW/LMHC/LPC/LMFT or RN) with 2–4 years of behavioral health experience, including utilization review and collaboration with Medicaid providers.

Qualifications

• Requires Master’s degree in Mental Health, Counseling, or Social Work and 2–4 years in behavioral health/psychiatric settings.
• Independent licensure as applicable by state; Texas licensure is referenced.
• Clinical knowledge to review and assess treatment plans related to mental health and substance abuse.
• Experience with Medicaid/State programs and utilization review processes preferred.

Responsibilities

• Evaluates member’s treatment for mental health and substance abuse to ensure medically appropriate level of care.
• Performs prior authorization reviews to determine medical appropriateness per guidelines.
• Conducts concurrent review of BH inpatient services and discharge planning.
• Analyzes BH member data to improve quality and utilization of services.
• Provides education to providers, members, and families regarding BH utilization processes.
• Interacts with BH providers and medical directors to improve care quality and efficiency.
• Formulates and presents cases during staffing and rounds.
• Complies with all policies and standards.

Skills

Auditing medical necessity reviews

BH utilization review

Care management collaboration

Provider education

Education

Master’s degree in Mental Health, Counseling, or Social Work

LCSW License

LMHC License

LPC License

LMFT License

RN License

Job description

Centene Corporation is seeking a health services professional to perform clinical documentation reviews and assess care for mental health and substance use services. The role monitors level of care and ensures medical appropriateness across BH therapies.

The candidate should hold an MSW/related master’s degree and have state licensure (LCSW/LMHC/LPC/LMFT or RN) with 2–4 years of behavioral health experience, including utilization review and collaboration with Medicaid providers.