Remote Behavioral Health Utilization Review Clinician

Centene Corp.; Northern (KY); Hybrid; USD 37,000 - 68,000; Full time

Job summary

Centene Corp. seeks an Utilization Review Clinician in a remote role requiring Georgia licensure. You will review mental health and substance use services, handling prior authorizations and concurrent inpatient reviews while collaborating with providers and medical directors.

The ideal candidate has BH experience, strong communication, and organizational skills to improve quality and utilization across care settings.

Qualifications

• Graduate of an accredited nursing program or bachelor's degree with related experience.
• Licensed to practice independently as per state requirements (Georgia preferred).
• Knowledge of mental health and substance use utilization review processes.

Responsibilities

• Evaluates BH treatment to ensure appropriate level of care.
• Performs prior authorization reviews for BH services.
• Conducts concurrent review of BH inpatient care and discharge planning.
• Analyzes BH data to improve quality and utilization.
• Educates providers, members, and families on BH utilization processes.
• Interacts with BH providers to discuss care levels and services.
• Engages with medical directors to improve care quality and efficiency.
• Formulates and presents cases in staffing and rounds.

Skills

Clinical review

BH utilization review

Provider-facing experience

Strong communication

Organizational skills

Adaptability

Education

Bachelor's degree

Master's degree in behavioral health

Graduate of Accredited Nursing program

Job description

Centene Corp. seeks an Utilization Review Clinician in a remote role requiring Georgia licensure. You will review mental health and substance use services, handling prior authorizations and concurrent inpatient reviews while collaborating with providers and medical directors.

The ideal candidate has BH experience, strong communication, and organizational skills to improve quality and utilization across care settings.