Remote Behavioral Health Utilization Review Clinician

Centene Corp.; Northern (KY); Hybrid; USD 77,424,000 - 139,116,000; Full time

Job summary

Centene Corp. is seeking an Utilization Review Clinician - Behavioral Health to conduct clinical reviews for mental health and substance use services, ensuring appropriate level of care for Oregon Medicaid in a fully remote role.

The position follows a Monday–Friday 8–5 Pacific schedule, with preference for applicants in any US time zone who hold independent licensure and BH utilization review experience.

Qualifications

• Graduate degree and licensure to practice independently; 2–4 years of related experience preferred.
• Master's degree in behavioral health required; state licensure preferred.
• Experience with BH utilization review processes and provider collaboration preferred.

Responsibilities

• Evaluates BH member data to determine level of care and medical necessity.
• Performs prior authorization reviews to determine medical appropriateness.
• Performs concurrent review of BH inpatient care and discharge planning.
• Analyzes BH data to improve quality and utilization of services.
• Provides education to providers, members, and families re BH utilization.
• Interacts with BH providers to discuss level of care and services.
• Engages with medical directors to improve quality and efficiency of care.
• Formulates and presents cases in staffing and rounds.
• Performs other duties as assigned; complies with policies.

Skills

Independent clinical licensure

Utilization management/review

Behavioral health review

BH level of care knowledge

Education

Bachelor's degree

Graduate of an Accredited School Nursing

Master's degree in Behavioral Health

Job description

Centene Corp. is seeking an Utilization Review Clinician - Behavioral Health to conduct clinical reviews for mental health and substance use services, ensuring appropriate level of care for Oregon Medicaid in a fully remote role.

The position follows a Monday–Friday 8–5 Pacific schedule, with preference for applicants in any US time zone who hold independent licensure and BH utilization review experience.