Remote Utilization Review Clinician - Behavioral Health

Centene Corporation

Nevada

Hybrid

USD 37,000 - 67,000

Full time

7 hours ago

Be an early applicant

Get a reply from this employer

Your resume and cover letter, tailored to exactly what they’re hiring for.

Get past ATS filters

Job summary

Centene Corporation is seeking a Behavioral Health Nurse/clinician to perform clinical review and assess care related to mental health and substance use. The role requires evaluating treatment, conducting prior authorizations, and facilitating discharge planning across shifts.

This position emphasizes collaboration with BH teams, data analysis to improve utilization, and education of providers, members, and families.

Qualifications

Requires graduate of an Accredited School Nursing or Bachelor's degree with 2–4 years of related experience.
Master’s degree for behavioral health clinicians required.
Licensure as applicable (LCSW/LMHC/LMFT/LMHP/RN) per state.
Clinical knowledge to review and assess treatment plans for BH and substance use.
Familiarity with BH utilization review process preferred.

Responsibilities

Evaluates member’s treatment for mental health and substance use to ensure medically appropriate level of care.
Performs prior authorization reviews to determine medical appropriateness per guidelines.
Performs concurrent BH inpatient reviews for discharge planning.
Analyzes BH data to improve quality and utilization of services.
Provides education to providers, members, and families re BH utilization process.
Interacts with BH healthcare providers to discuss level of care and services.
Engages with medical directors to improve care quality and efficiency.
Formulates and presents cases in staffing and integrated rounds.
Performs other duties as assigned.
Complies with all policies and standards.