Remote Behavioral Health Utilization Review Clinician

Centene Corporation; United States; Remote; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Job summary

Centene Corporation seeks a remote Behavioral Health reviewer to support the Texas Ambetter Inpatient Behavioral Health population. The role requires 4 x 10-hour shifts weekly with Saturday availability; weekend differential is offered.

You will evaluate care, perform prior authorizations, and participate in discharge planning to ensure medically appropriate services. Requires nursing education (RN) with state licensure; master's in behavioral health preferred.

Qualifications

• Requires nursing license and clinical knowledge in mental health/substance abuse utilization review.
• Experience with providers and healthcare teams to review care services.
• Master’s degree in behavioral health is preferred but not required.

Responsibilities

• Evaluates treatment for mental health and substance use to ensure medically appropriate level of care.
• Performs prior authorization reviews for BH/ substance use.
• Performs concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve quality and utilization.
• Provides education to providers, members, and families on BH utilization.

Skills

Clinical review

BH inpatient

Regulatory guidelines

Education

Bachelor’s degree in Nursing or related field

Job description

Centene Corporation seeks a remote Behavioral Health reviewer to support the Texas Ambetter Inpatient Behavioral Health population. The role requires 4 x 10-hour shifts weekly with Saturday availability; weekend differential is offered.

You will evaluate care, perform prior authorizations, and participate in discharge planning to ensure medically appropriate services. Requires nursing education (RN) with state licensure; master's in behavioral health preferred.