Remote Behavioral Health Utilization Review Clinician

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

Benefits offered by this job

Health insurance

401K

Stock plan

Tuition reimbursement

Paid time off

Remote/hybrid options

Job summary

Centene Corporation seeks a Clinical Review professional to assess mental health and substance use care, evaluating treatment plans and determining appropriate levels of care. You will support concurrent BH reviews and work with providers to ensure quality and compliance.

Role requires licensure and a master's in behavioral health for clinicians; opportunities include remote or hybrid schedules and a comprehensive benefits package.

Qualifications

• Requires graduate nursing or a bachelor's degree with 2–4 years of related experience.
• Current license to practice independently per state requirements.
• Master's degree in behavioral health is required.
• Licensure options include LCSW, LMHC, LPC, LMFT, LMHP, or RN.

Responsibilities

• Perform clinical review of mental health and substance abuse care levels.
• Conduct prior authorization reviews for clinical appropriateness.
• Review BH inpatient cases and discharge planning.
• Analyze BH data to improve utilization and quality.
• Educate providers, members, and families on BH utilization.
• Collaborate with medical directors to improve care quality.
• Present cases in staffing and rounds.
• Adhere to policies and standards.

Education

Graduate of an Accredited School Nursing

Bachelor's degree

Job description

Centene Corporation seeks a Clinical Review professional to assess mental health and substance use care, evaluating treatment plans and determining appropriate levels of care. You will support concurrent BH reviews and work with providers to ensure quality and compliance.

Role requires licensure and a master's in behavioral health for clinicians; opportunities include remote or hybrid schedules and a comprehensive benefits package.