Remote Behavioral Health Utilization Review Clinician

Centene Management Company LLC; New York (NY); Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Job summary

Centene is seeking a licensed clinician to remotely perform clinical reviews and assess care for mental health and substance abuse. The role requires active licensure and strong knowledge of BH utilization review, with NY licensure preferred. Standard business hours apply Eastern Time, Monday through Friday.

Responsibilities include evaluating care levels, prior authorization reviews, concurrent inpatient review, and provider education. A master’s in behavioral health is preferred.

Qualifications

• Experience in mental health and substance abuse utilization review.
• Ability to assess treatment plans and care levels.
• Knowledge of regulatory guidelines for BH services.

Responsibilities

• Evaluates treatment for mental health and substance abuse to ensure medical appropriateness.
• Performs prior authorization reviews for BH services.
• Performs concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve quality and utilization.
• Provides education to providers, members and families regarding BH utilization.
• Interacts with BH providers and medical directors to improve care quality.

Skills

Mental health

Substance abuse

Clinical review

Prior authorization

Education and training

Education

Bachelor's degree

Nursing license

Master’s degree in behavioral health

Job description

Centene is seeking a licensed clinician to remotely perform clinical reviews and assess care for mental health and substance abuse. The role requires active licensure and strong knowledge of BH utilization review, with NY licensure preferred. Standard business hours apply Eastern Time, Monday through Friday.

Responsibilities include evaluating care levels, prior authorization reviews, concurrent inpatient review, and provider education. A master’s in behavioral health is preferred.