Remote Behavioral Health Utilization Review Clinician

IntelliResume; North Carolina; On-site; 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

field, or office

Job summary

Centene is seeking a remote Utilization Review Clinician - Behavioral Health based in North Carolina. You will evaluate treatment plans, perform prior authorizations, and conduct concurrent reviews for mental health and substance use services.

Ideal candidates hold a master’s in behavioral health, relevant licensure (LCSW/LMHC/LPC/LMFT/LMHP or RN), and 2–4 years of related experience. Flexible remote/hybrid options are available, with competitive compensation.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree required
• Master's degree for behavioral health clinicians required
• 2-4 years of related behavioral health and utilization review experience preferred
• Licensure as LCSW, LMHC, LPC, LMFT, LMHP or RN with state/compact licensure required

Responsibilities

• Evaluate members' treatment for mental health and substance use disorders to ensure medical appropriateness
• Perform prior authorization reviews for mental health and substance use services
• Conduct concurrent reviews of behavioral health inpatient cases for treatment needs and discharge planning
• 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 providers to discuss levels of care and services
• Engage with medical directors and leadership to enhance care quality and efficiency
• Present cases in staffing and integrated rounds
• Perform other duties as assigned
• Comply with all policies and standards

Skills

Behavioral health experience

Utilization review

Prior authorization

Data analysis

Education

Bachelor's degree

Master's degree in behavioral health

Tools

LCSW

LMHC

LPC

LMFT

LMHP

RN

Job description

Centene is seeking a remote Utilization Review Clinician - Behavioral Health based in North Carolina. You will evaluate treatment plans, perform prior authorizations, and conduct concurrent reviews for mental health and substance use services.

Ideal candidates hold a master’s in behavioral health, relevant licensure (LCSW/LMHC/LPC/LMFT/LMHP or RN), and 2–4 years of related experience. Flexible remote/hybrid options are available, with competitive compensation.