Remote Utilization Review Clinician, Behavioral Health

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

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Job summary

Centene Corporation seeks a Clinical Reviewer focused on mental health and substance use care. The role conducts clinical reviews, prior authorizations, and concurrent assessments to ensure appropriate levels of care, working with BH providers and leadership.

The position is remote within the Central Time Zone, with standard hours Mon–Fri 8am–5pm and occasional weekend/holiday coverage. Requires nursing degree and state licensure; Master’s in Behavioral Health preferred.

Qualifications

• Graduate of an Accredited School Nursing or Bachelor's degree and 2–4 years of related experience.
• State licensure to practice independently and/or as outlined by state requirements.
• Master's degree for behavioral health clinicians preferred.
• Knowledge of BH utilization review process preferred.
• Experience working with providers and healthcare teams to review BH services preferred.

Responsibilities

• Evaluates member’s mental health and substance abuse treatment to ensure medical appropriateness.
• Performs prior authorization reviews for BH care according to guidelines.
• Performs concurrent BH inpatient reviews for discharge planning and needs assessment.
• Analyzes BH member data to improve quality and appropriate utilization of services.
• Provides education to providers, members, and families regarding BH processes.
• Interacts with BH healthcare providers to discuss level of care and services.
• Collaborates with medical directors and leadership to improve care quality and efficiency.
• Formulates and presents cases in staffing and integrated rounds.
• Performs other duties as assigned and complies with policies.

Skills

Clinical review

BH utilization review

Interdisciplinary collaboration

Regulatory compliance

Education

Bachelor's degree in nursing or related field

Master's in Behavioral Health (preferred)

Job description

Centene Corporation seeks a Clinical Reviewer focused on mental health and substance use care. The role conducts clinical reviews, prior authorizations, and concurrent assessments to ensure appropriate levels of care, working with BH providers and leadership.

The position is remote within the Central Time Zone, with standard hours Mon–Fri 8am–5pm and occasional weekend/holiday coverage. Requires nursing degree and state licensure; Master’s in Behavioral Health preferred.