Remote Behavioral Health Utilization Review Specialist

Centene Corporation; Florida; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Remote, hybrid, field or office work

Job summary

Centene Corporation is seeking a clinical reviewer to assess mental health and substance abuse care, ensuring medically appropriate levels of care and services. The role involves prior and concurrent reviews, education for providers and families, and collaboration with BH teams and medical directors.

The position requires a Master’s degree in a related field and an independent state license. Familiarity with Medicaid/Medicare and utilization review is preferred.

Qualifications

• Requires Master’s degree related to Mental Health, Counseling, or Social Work.
• License to practice independently in the applicable state is required.
• Clinical knowledge to review treatment plans for mental health/substance abuse preferred.
• Knowledge of BH utilization review process preferred.
• Experience working with mental health providers and BH teams.

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.
• Performs concurrent review of BH inpatient care and discharge planning.
• Analyzes BH data to improve quality and utilization.
• Educates providers, members, and families on BH utilization processes.
• Interacts with BH providers to discuss level of care.
• Collaborates with medical directors to improve care quality and efficiency.
• Presents cases during staffing and integrated rounds.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Auditing medical necessity reviews

BH utilization review

Medicaid/Medicare collaboration

Clinical collaboration with BH teams

Education

Master’s degree in Mental Health/Counseling/Social Work

Job description

Centene Corporation is seeking a clinical reviewer to assess mental health and substance abuse care, ensuring medically appropriate levels of care and services. The role involves prior and concurrent reviews, education for providers and families, and collaboration with BH teams and medical directors.

The position requires a Master’s degree in a related field and an independent state license. Familiarity with Medicaid/Medicare and utilization review is preferred.