Remote Utilization Review Clinician - Behavioral Health

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

Benefits offered by this job

Health insurance

401(k) and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules (remote/hybrid

Job summary

Centene Corporation is seeking a qualified clinician to perform clinical documentation reviews and prevention of inappropriate BH utilization. The role focuses on mental health and substance abuse care, with prior authorization and concurrent review responsibilities.

Ideal candidates hold a relevant master’s degree and state licensure, possess BH knowledge, and have experience reviewing treatment plans and utilization reviews.

Qualifications

• Master’s degree in mental health fields or nursing with licensure is required.
• Independent licensure by the applicable state is required.
• Experience reviewing BH treatment plans and utilization review is preferred.

Responsibilities

• Evaluate member treatment for mental health/substance use to ensure medically appropriate level of care.
• Perform prior authorization reviews for BH services per regulatory criteria.
• Conduct concurrent BH inpatient reviews and discharge planning.
• Analyze BH data to improve service utilization and quality.
• Educate providers, members, and families on BH utilization processes.
• Engage with medical directors to improve care quality and efficiency.
• Present cases in staffing and rounds; comply with all policies.

Skills

Behavioral health knowledge

Utilization review experience

Auditing medical necessity

Medicaid provider collaboration

Education

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

Licensed independent practice (LCSW/LMHC/LPC/LMFT or RN)

Job description

Centene Corporation is seeking a qualified clinician to perform clinical documentation reviews and prevention of inappropriate BH utilization. The role focuses on mental health and substance abuse care, with prior authorization and concurrent review responsibilities.

Ideal candidates hold a relevant master’s degree and state licensure, possess BH knowledge, and have experience reviewing treatment plans and utilization reviews.