Remote Behavioral Health Utilization Review Clinician

Centene Corporation; Seattle (WA); Remote; USD 37,000 - 66,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote/hybrid/field or office work

Job summary

Centene Corporation is seeking a skilled clinician to perform clinical reviews and assess care for mental health and substance use. This remote role requires an active Washington RN or Compact RN license and offers weekday hours with weekend/holiday rotation.

You will evaluate treatment plans, authorize BH services, participate in rounds, educate providers and families, and collaborate with medical directors to improve quality and efficiency.

Qualifications

• RN license required; active license to practice
• Master’s degree for behavioral health clinicians preferred
• Clinical knowledge to review treatment plans for mental health/substance abuse
• Experience working with providers/teams on care review preferred

Responsibilities

• Evaluates treatment for mental health/substance abuse before, during, and after services
• Performs prior authorization reviews for medical appropriateness
• Performs concurrent review of BH inpatient care
• Analyzes BH data to improve quality and utilization
• Educates providers, members and families on BH utilization process
• Interacts with BH providers to discuss level of care/services
• Engages with medical directors to improve care quality/efficiency
• Presents cases in staffing and rounds
• Performs other duties and adheres to policies

Skills

RN license

BH clinical knowledge

Utilization review

Education

Bachelor's degree in nursing

Master's degree in behavioral health

Job description

Centene Corporation is seeking a skilled clinician to perform clinical reviews and assess care for mental health and substance use. This remote role requires an active Washington RN or Compact RN license and offers weekday hours with weekend/holiday rotation.

You will evaluate treatment plans, authorize BH services, participate in rounds, educate providers and families, and collaborate with medical directors to improve quality and efficiency.