Remote Utilization Review Clinician — Behavioral Health

Centene Corporation; Arkansas; 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 + holidays

Flexible remote/hybrid/office options

Job summary

Centene Corporation is seeking a Behavioral Health Utilization Review Specialist to support clinical reviews for mental health and substance use services. This role is remote within the Central Time Zone with a Monday–Friday schedule and occasional weekend or holiday work.

The position requires nursing licensure (RN or equivalent) and 2–4 years of related experience; a master's in behavioral health is preferred.

Qualifications

• Requires RN or related nursing licensure.
• Master's degree in behavioral health preferred.
• 2–4 years of related experience in mental health/substance use.
• Knowledge of utilization review processes preferred.

Responsibilities

• Evaluate member treatment for mental health/substance use before, during, and after services.
• Perform prior authorization reviews to determine medical appropriateness.
• Conduct concurrent review of inpatient behavioral health services.
• Educate providers, members, and families on BH utilization processes.

Skills

Clinical review

Care assessment

Education to providers

Interacts with BH providers

Education

Bachelor's degree in Nursing

Master's degree in Behavioral Health

Job description

Centene Corporation is seeking a Behavioral Health Utilization Review Specialist to support clinical reviews for mental health and substance use services. This role is remote within the Central Time Zone with a Monday–Friday schedule and occasional weekend or holiday work.

The position requires nursing licensure (RN or equivalent) and 2–4 years of related experience; a master's in behavioral health is preferred.