Remote Behavioral Health Utilization Review Clinician

Centene Corporation; WaKeeney (KS); Remote; USD 37,000 - 68,000; Full time

Benefits offered by this job

Benefits package

Remote work flexibility

Job summary

Centene Corporation is seeking a fully remote Behavioral Health Utilization Review Specialist. The role focuses on evaluating mental health and substance use care, performing prior-authorizations, and conducting concurrent reviews to ensure medically appropriate levels of care.

It requires licensure (LCSW/LMHC/ LPC/LMFT/LMHP or RN) and relevant behavioral health credentials. Strong communication with providers, leadership, and health plans is essential, with opportunities to educate teams and

Qualifications

• Graduate of an accredited nursing school or bachelor’s degree with 2–4 years of related experience.
• State licensure as required by the applicable state; master’s degree for behavioral health clinicians.
• LCSW/LMHC/LPC/LMFT/LMHP or RN licensure may be required.

Responsibilities

• Evaluate mental health and substance abuse treatment for medical necessity.
• Perform prior authorization reviews for BH services.
• Conduct concurrent BH inpatient reviews and discharge planning.
• Analyze BH data to improve service utilization and quality.
• Educate providers and families on BH utilization processes.
• Engage with medical directors to improve care quality and efficiency.
• Present cases in staffing and rounds; comply with policies.

Skills

Clinical review

Utilization management

Provider coaching

Stakeholder communication

Education

Bachelor's degree

Master’s degree in behavioral health

Tools

Regulatory knowledge

Job description

Centene Corporation is seeking a fully remote Behavioral Health Utilization Review Specialist. The role focuses on evaluating mental health and substance use care, performing prior-authorizations, and conducting concurrent reviews to ensure medically appropriate levels of care.

It requires licensure (LCSW/LMHC/ LPC/LMFT/LMHP or RN) and relevant behavioral health credentials. Strong communication with providers, leadership, and health plans is essential, with opportunities to educate teams and