Remote Behavioral Health Utilization Review Clinician

Centene Corp.; Washington; Remote; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible remote/hybrid/office work

Job summary

Centene Corp. is seeking a remote clinical reviewer to assess mental health and substance use care, ensure appropriate level of care, and support utilization management. The role covers prior authorization, concurrent BH reviews, and provider coaching, with presentations to leadership.

Applicants should hold necessary BH licenses (LCSW/LMHC/LCPC/LMFT/LMHP or RN) and have 2–4 years of related experience, with a Master’s degree in behavioral health preferred.

Qualifications

• Requires Graduate of an Accredited School Nursing or Bachelor's degree with 2–4 years of related experience.
• Independent licensure to practice behavioral health per state requirements.
• Master’s degree in behavioral health is required.
• Knowledge of BH utilization review processes is preferred.
• Experience working with providers and healthcare teams on care services.

Responsibilities

• Evaluates member’s treatment for mental health and substance abuse to ensure medically appropriate level of care.
• Performs prior authorization reviews for BH services per regulatory guidelines.
• Conducts concurrent BH inpatient reviews for discharge planning and needs.
• Analyzes BH data to improve quality and utilization.
• Educates providers, members, and families on BH utilization processes.
• Interacts with BH providers and discusses level of care with leadership.
• Engages with medical directors to enhance care quality and efficiency.
• Formulates cases for staffing and rounds.
• Performs other duties as assigned and adheres to policies.

Skills

Independent behavioral health license

Utilization management

Provider education

Leadership presentation

Clinical record reviews

Education

Bachelor's degree

Master's degree in behavioral health

RN licensure (state)

Job description

Centene Corp. is seeking a remote clinical reviewer to assess mental health and substance use care, ensure appropriate level of care, and support utilization management. The role covers prior authorization, concurrent BH reviews, and provider coaching, with presentations to leadership.

Applicants should hold necessary BH licenses (LCSW/LMHC/LCPC/LMFT/LMHP or RN) and have 2–4 years of related experience, with a Master’s degree in behavioral health preferred.