Remote Behavioral Health Utilization Review Clinician

Centene; New York (NY); Remote; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,hybrid

Job summary

Centene seeks an Utilization Review Clinician - Behavioral Health for a fully remote role serving New York. You will perform clinical reviews, assess care levels, and authorize mental health/substance abuse services.

Requires a clinical license (RN or LMSW/LCSW/LMHC/LPC/LMFT/LMHP) and a bachelor’s degree with 2–4 years of related experience. The role emphasizes education for providers and members, collaboration with medical directors, and ensuring medical appropriateness of care in a day-shift,

Qualifications

• Bachelor's degree required or graduation from an accredited school of nursing.
• Licensure options include LMSW, LCSW, LMHC, LPC, LMFT, LMHP, or RN.
• 2–4 years of related experience preferred.

Responsibilities

• Evaluate member’s treatment for mental health and substance abuse to ensure medical appropriateness.
• Perform prior authorization reviews related to mental health and substance abuse.
• 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 the behavioral health utilization process.
• 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.

Education

Bachelor's degree

Nursing degree

Job description

Centene seeks an Utilization Review Clinician - Behavioral Health for a fully remote role serving New York. You will perform clinical reviews, assess care levels, and authorize mental health/substance abuse services.

Requires a clinical license (RN or LMSW/LCSW/LMHC/LPC/LMFT/LMHP) and a bachelor’s degree with 2–4 years of related experience. The role emphasizes education for providers and members, collaboration with medical directors, and ensuring medical appropriateness of care in a day-shift,