Remote Behavioral Health Utilization Review Clinician

Centene Corporation; Sacramento (CA); À distance; USD 37 000 - 68 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Résumé du poste

Centene Corporation offers a fully remote clinical reviewer position focused on mental health and substance use care within the California Market. The role requires evaluating care, conducting prior authorizations, and coordinating with providers across states with Pacific time scheduling.

Qualifications include nursing or related bachelor’s degree and master’s level behavioral health training, with licenses to practice.

Qualifications

• Clinical knowledge to review and assess treatment plans.
• Experience with mental health and substance use utilization review preferred.
• Ability to work with providers and healthcare teams.

Responsabilités

• Evaluates treatment for mental health and substance use to ensure medically appropriate level of care.
• Performs prior authorization reviews for BH services.
• Performs concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve utilization and quality.
• Educates providers, members, and families on BH utilization processes.
• Interacts with BH healthcare providers and medical leadership to improve care quality.

Connaissances

Clinical review

Utilization management

Healthcare collaboration

Formation

Bachelor's degree in Nursing or related field

Master's degree in Behavioral Health

Description du poste

Centene Corporation offers a fully remote clinical reviewer position focused on mental health and substance use care within the California Market. The role requires evaluating care, conducting prior authorizations, and coordinating with providers across states with Pacific time scheduling.

Qualifications include nursing or related bachelor’s degree and master’s level behavioral health training, with licenses to practice.