Remote Behavioral Health Utilization Review Clinician

Centene Corporation; Northern (KY); 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

Flexible remote/work schedules

Job summary

Centene Corporation is seeking a remote Clinical Reviewer with mental health and substance use experience. The role requires active Georgia licensure, BH expertise, and strong communication with providers and families.

Typical schedule is Monday–Friday, 8:00 AM–5:00 PM, with rotating holidays and weekends. The position involves evaluating care, performing prior and concurrent reviews, and collaborating with medical leadership to ensure appropriate services while navigating regulatory guidelines.

Qualifications

• Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2–4 years of related experience.
• Active Georgia Licensed Clinician or Compact Nursing License.
• Master’s degree for behavioral health clinicians required.
• Clinical knowledge to review and assess treatment plans for mental health and substance abuse.

Responsibilities

• Evaluates member’s treatment for mental health and substance abuse to ensure medically appropriate level of care.
• Performs prior authorization reviews related to BH to determine medical appropriateness.
• Performs concurrent review of BH inpatient for treatment needs and discharge planning.
• Analyzes BH data to improve quality and appropriate utilization of services.
• Provides education to providers, members, and families re BH utilization process.
• Interacts with BH providers to discuss level of care and services.
• Engages with medical directors and leadership to improve quality and efficiency of care.
• Formulates and presents cases in staffing and integrated rounds.
• Performs other duties as assigned and complies with policies.

Skills

Behavioral health

Clinical review

Prior authorization

Provider-facing

Communication

Customer service

Organizational skills

Education

Bachelor's degree

Master's degree in behavioral health

Nursing degree (RN)

Job description

Centene Corporation is seeking a remote Clinical Reviewer with mental health and substance use experience. The role requires active Georgia licensure, BH expertise, and strong communication with providers and families.

Typical schedule is Monday–Friday, 8:00 AM–5:00 PM, with rotating holidays and weekends. The position involves evaluating care, performing prior and concurrent reviews, and collaborating with medical leadership to ensure appropriate services while navigating regulatory guidelines.