Remote Behavioral Health Utilization Review Clinician

IntelliResume; Washington; On-site; USD 37,000 - 68,000; Full time

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 an Utilization Review Clinician - Behavioral Health to perform clinical reviews and assess care for mental health and substance use. This remote role supports clinicians across the continuum of care while collaborating with providers to determine appropriate levels of care.

Responsibilities include evaluating treatment, conducting prior authorization and concurrent reviews, and educating providers and families on utilization processes.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree required.
• Master's degree for behavioral health clinicians required.
• One of the following licenses required: LCSW, LMHC, LPC, LMFT, LMHP, or RN licensure.

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 their families regarding behavioral health utilization processes.
• Interact with behavioral health healthcare providers to discuss levels of care.
• Engage with medical directors and leadership to enhance care quality and efficiency.
• Formulate and present cases in staffing and integrated rounds.
• Perform other duties as assigned.
• Comply with all policies and standards.

Education

Bachelor's degree

Master's degree

Job description

Centene is seeking an Utilization Review Clinician - Behavioral Health to perform clinical reviews and assess care for mental health and substance use. This remote role supports clinicians across the continuum of care while collaborating with providers to determine appropriate levels of care.

Responsibilities include evaluating treatment, conducting prior authorization and concurrent reviews, and educating providers and families on utilization processes.