Remote Utilization Review Clinician - Behavioral Health

Centene Management Company LLC

Louisiana (MO)

Hybrid

USD 40,000 - 66,000

Full time

9 days ago

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Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Management Company LLC in Louisiana seeks a qualified clinician to perform clinical reviews and assess care related to mental health and substance abuse. You will monitor level of care and determine whether services are medically appropriate.

The role requires an active Louisiana license, a nursing or behavioral health degree, and 2–4 years of related experience. You will participate in prior authorization reviews, inpatient BH reviews, and collaborate with providers and medical

Qualifications

Graduate of an accredited nursing program or a bachelor's degree with 2–4 years of related experience.
Active, unrestricted Louisiana licensure required (RN, LCSW, LMHC, LPC, LMFT, LMHP or LMHP).
Master’s degree in behavioral health required for clinicians.
Experience with mental health and substance abuse utilization review preferred.

Responsibilities

Evaluates BH/SA treatment before, during, and after services to ensure medical appropriateness.
Performs prior authorization reviews related to BH/SA to determine medical appropriateness.
Performs concurrent review of BH inpatient to determine overall health, needs, and discharge planning.
Analyzes BH member data to improve quality and appropriate utilization of services.
Provides education to providers, members and families re BH utilization processes.
Interacts with BH healthcare providers to discuss level of care and services.
Engages with medical directors and leadership to improve quality and efficiency of care.
Formulates and presents cases in staffing and integrated rounds.
Performs other duties as assigned and complies with all policies and standards.