Remote Behavioral Health Utilization Review Clinician

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

Benefits offered by this job

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene Corporation seeks a Behavioral Health Utilization Review professional to perform clinical reviews and assess the appropriateness of mental health and substance use services. This fully remote role supports Ambetter / Marketplace, reviewing requests for inpatient, residential treatment, and partial hospitalization.

Schedule is Mon–Fri, 8–5 in Eastern or Central time. Ideal candidates have nursing/advanced degrees and 2–4 years in utilization management, with BH credentials preferred.

Qualifications

• Requires nursing or related Bachelor's degree and 2–4 years of related experience.
• Master’s degree for behavioral health clinicians is required.
• Licensure to practice independently per state requirements.

Responsibilities

• Evaluate mental health and substance use care before, during, and after services.
• Perform prior authorization reviews to determine medical appropriateness.
• Conduct concurrent review of BH inpatient care and discharge planning.
• Analyze BH data to improve quality and utilization of services.
• Provide education to providers, members, and families about BH utilization processes.
• Collaborate with BH providers and medical directors to improve care quality.
• Present cases in staffing and integrated rounds.

Skills

Utilization management

Clinical review

Interpersonal skills

Documentation

Education

Bachelor's degree

RN license

Master's in Behavioral Health

Job description

Centene Corporation seeks a Behavioral Health Utilization Review professional to perform clinical reviews and assess the appropriateness of mental health and substance use services. This fully remote role supports Ambetter / Marketplace, reviewing requests for inpatient, residential treatment, and partial hospitalization.

Schedule is Mon–Fri, 8–5 in Eastern or Central time. Ideal candidates have nursing/advanced degrees and 2–4 years in utilization management, with BH credentials preferred.