Remote Mental Health Utilization Review Clinician

Centene Corporation; Washington; 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

Job summary

Centene Corporation is seeking a remote Behavioral Health RN reviewer to assess care related to mental health and substance use disorders. You will participate in weekend/holiday rotations and must hold an RN license active in Washington or a compact state.

You will evaluate care plans, perform prior authorizations, and collaborate with medical directors to ensure appropriate services, quality, and outcomes for members across programs.

Qualifications

• Graduate of an Accredited School Nursing or Bachelor’s degree with 2–4 years of related experience.
• State licensure to practice independently as outlined by state requirements.
• Master’s degree in behavioral health required for clinicians.

Responsibilities

• Evaluate member’s treatment for mental health and substance abuse to ensure appropriate level of care.
• Perform prior authorization reviews per regulatory guidelines.
• Conduct concurrent review of BH inpatient stays and discharge planning.
• Analyze BH data to improve service quality and utilization.
• Educate providers, members and families on BH utilization processes.

Skills

Clinical review

Behavioral health

Policy compliance

Team collaboration

Education

Master’s in behavioral health

RN license

Job description

Centene Corporation is seeking a remote Behavioral Health RN reviewer to assess care related to mental health and substance use disorders. You will participate in weekend/holiday rotations and must hold an RN license active in Washington or a compact state.

You will evaluate care plans, perform prior authorizations, and collaborate with medical directors to ensure appropriate services, quality, and outcomes for members across programs.