Remote Behavioral Health Utilization Review Clinician

Centene Corp.; Nebraska; Remote; USD 37,000 - 67,000; Full time

Job summary

Centene Corp. is seeking a remote Behavioral Health Utilization Review specialist to evaluate mental health and substance use treatment, perform prior and concurrent reviews, and coach providers on care quality and utilization.

The role emphasizes collaboration with medical directors and leadership to improve care efficiency, with a schedule aligned to multiple time zones. Licensure in behavioral health is highly preferred.

Qualifications

• Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2–4 years of related experience.
• License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
• Master’s degree for behavioral health clinicians required.
• Knowledge of mental health and substance abuse utilization review process preferred.
• Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.

Responsibilities

• Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate.
• Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria.
• Performs concurrent review of behavioral health inpatient to determine overall health of member, treatment needs, and discharge planning.
• Analyzes BH member data to improve quality and appropriate utilization of services.
• Provides education to providers members and their families regrading BH utilization process.
• Interacts with BH healthcare providers as appropriate to discuss level of care and/or services.
• Engages with medical directors and leadership to improve the quality and efficiency of care.
• Formulates and presents cases in staffing and integrated rounds.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Utilization management

Clinical reviews

Provider education

Remote work

Education

Bachelor's degree

Master's degree in Behavioral Health

RN license

LCSW

LMHC

LPC

LMFT

LMHP

Job description

Centene Corp. is seeking a remote Behavioral Health Utilization Review specialist to evaluate mental health and substance use treatment, perform prior and concurrent reviews, and coach providers on care quality and utilization.

The role emphasizes collaboration with medical directors and leadership to improve care efficiency, with a schedule aligned to multiple time zones. Licensure in behavioral health is highly preferred.