Remote Behavioral Health Utilization Review Clinician

Centene

Oregon

Remote

USD 56,000 - 101,000

Full time

4 days ago

Be an early applicant

Application generator

Don’t send a generic resume — generate a resume and cover letter tailored to this exact role.

Get past ATS filters

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene is seeking a remote Utilization Review Clinician - Behavioral Health to support Oregon Medicaid. The role requires independent clinical licensure and experience in behavioral health and utilization management.

It offers a full-time day-shift schedule and a nationwide remote work option within Oregon Medicaid guidelines. The candidate should have a graduate degree in nursing or a relevant field, plus a master's in behavioral health, and 2–4 years of related experience.

Qualifications

Graduate of an Accredited School of Nursing or Bachelor's degree required.
Master's degree required for behavioral health clinicians.

Responsibilities

Evaluate member's treatment for mental health and substance abuse before, during, and after services.
Perform prior authorization reviews related to mental health and substance abuse.
Conduct concurrent reviews of behavioral health inpatient cases.
Analyze behavioral health member data to improve service utilization.
Provide education to providers, members, and families regarding behavioral health utilization processes.
Interact with behavioral health healthcare providers to discuss levels of care and services.
Engage with medical directors and leadership to enhance care quality and efficiency.