Remote Behavioral Health Utilization Review Clinician

Centene Corporation; Oregon; Hybrid; USD 37.000 - 68.000; Vollzeit

Zusammenfassung

Centene Corporation is seeking a remote Behavioral Health Clinical Reviewer to support Oregon Medicaid. The role conducts clinical reviews for mental health and substance use care, performs prior authorization and concurrent reviews, and collaborates with providers and medical leadership to ensure appropriate levels of care and efficient utilization of services.

Required qualifications include a nursing or related degree with 2-4 years of experience and a master’s degree in behavioral health.

Qualifikationen

• Requires Graduate of an Accredited School Nursing or Bachelor's degree with 2-4 years of related experience.
• License to practice independently, and/or state required licensure as applicable.
• Master’s degree for behavioral health clinicians required.
• Clinical knowledge to review and assess treatment plans related to mental health and substance abuse preferred.
• Knowledge of mental health and substance abuse utilization review process preferred.
• Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.

Aufgaben

• Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure medically appropriate level of care.
• Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness.
• Performs concurrent review of behavioral health inpatient to determine overall health, treatment needs, and discharge planning.
• Analyzes BH member data to improve quality and appropriate utilization of services.
• Provides education to providers, members and their families regrading BH utilization process.
• Interacts with BH healthcare 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.
• Complies with all policies and standards.

Kenntnisse

Clinical review

Utilization review

Team collaboration

Independent licensure

Ausbildung

Bachelor's degree

Nursing degree (RN)

Master’s degree (behavioral health)

Jobbeschreibung

Centene Corporation is seeking a remote Behavioral Health Clinical Reviewer to support Oregon Medicaid. The role conducts clinical reviews for mental health and substance use care, performs prior authorization and concurrent reviews, and collaborates with providers and medical leadership to ensure appropriate levels of care and efficient utilization of services.

Required qualifications include a nursing or related degree with 2-4 years of experience and a master’s degree in behavioral health.