Remote Behavioral Health Utilization Review Clinician

Centene Corporation; Nevada (IA); Remote; USD 37,000 - 67,000; Full time

Benefits offered by this job

Fully remote

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Corporation offers a fully remote role focused on reviewing behavioral health authorizations for inpatient, residential treatment, and partial hospitalization. The schedule is Monday through Friday, 8-5 pm Eastern or Central, with preference for candidates in central or eastern time zones.

The position requires a graduate of an accredited nursing school or a bachelor’s degree with 2–4 years of related experience.

Qualifications

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

Responsibilities

• Evaluates mental health and substance abuse treatment before, during, and after services to ensure appropriate level of care.
• Performs prior authorization reviews to determine medical appropriateness.
• Performs concurrent BH inpatient review for health status, needs, and discharge planning.
• Analyzes BH data to improve quality and appropriate utilization of services.
• Provides education to providers, members, and families regarding BH utilization process.
• Interacts with BH providers to discuss level of care and services.
• Engages with medical directors and leadership to improve care quality and efficiency.
• Participates in staffing and integrated rounds to present cases.
• Complies with all policies and standards.

Skills

Utilization review

Prior authorization

Clinical knowledge

Communication with providers

Team collaboration

Education

Bachelor's degree

Master’s degree in Behavioral Health

Job description

Centene Corporation offers a fully remote role focused on reviewing behavioral health authorizations for inpatient, residential treatment, and partial hospitalization. The schedule is Monday through Friday, 8-5 pm Eastern or Central, with preference for candidates in central or eastern time zones.

The position requires a graduate of an accredited nursing school or a bachelor’s degree with 2–4 years of related experience.