Remote Behavioral Health Utilization Review Clinician

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

Benefits offered by this job

Health insurance

401K and stock plans

Paid time off + holidays

Job summary

Centene Corporation is seeking a remote Clinical Review Nurse to assess mental health and substance use care. The role monitors level of care, performs prior authorizations and concurrent reviews, and collaborates with providers to optimize BH utilization.

A nursing degree plus 2–4 years of related experience is required; NY licensure is strongly preferred. Remote position with standard business hours in Eastern Time.

Qualifications

• Requires nursing degree or bachelor’s degree with 2–4 years of related experience.
• Master’s degree in behavioral health required.
• Active nursing license or state licensure required; NY licensure strongly preferred.

Responsibilities

• Evaluate mental health and substance use treatment for appropriateness.
• Perform prior authorization reviews for BH services.
• Conduct concurrent BH inpatient reviews and discharge planning.
• Provide education to providers, members and families on BH utilization.
• Engage with medical directors to improve care quality and efficiency.
• Present cases in staffing and integrated rounds.
• Adhere to all policies and standards.

Skills

Clinical review

Utilization review

Team collaboration

Education to providers

Education

Bachelor's degree

Master’s degree in behavioral health

RN license

Job description

Centene Corporation is seeking a remote Clinical Review Nurse to assess mental health and substance use care. The role monitors level of care, performs prior authorizations and concurrent reviews, and collaborates with providers to optimize BH utilization.

A nursing degree plus 2–4 years of related experience is required; NY licensure is strongly preferred. Remote position with standard business hours in Eastern Time.