Remote Utilization Review Clinician - Behavioral Health

Centene Corporation; Salem (OR); Remote; USD 37,000 - 66,000; Full time

Benefits offered by this job

Remote work option

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Corporation seeks a behavioral health clinical reviewer to conduct comprehensive BH reviews for inpatient and outpatient settings. This fully remote role supports Oregon Medicaid with a weekday schedule 8–5 PT.

Applicants with independent licensure and BH utilization review experience are preferred. Master’s in behavioral health is required, and multiple BH licenses are listed as acceptable credentials.

Qualifications

• Requires graduate of an accredited nursing school or bachelor’s degree with 2–4 years related experience.
• State licensure to practice independently; master’s degree in behavioral health clinicals preferred.
• Licenses (LCSW, LMHC, LPC, LMFT, LMHP, RN) are required.
• Experience with providers and healthcare teams to review care for mental health/substance use disorders preferred.

Responsibilities

• Evaluates member’s treatment for mental health and substance abuse to ensure medical appropriateness.
• Performs prior authorization reviews for BH services as per guidelines.
• Performs concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve quality and utilization of services.
• Educates providers, members, and families on BH utilization processes.
• Interacts with BH providers and medical directors to improve care quality and efficiency.
• Presents cases in staffing and integrated rounds.
• Performs other duties as assigned.
• Complies with policies and standards.

Skills

Clinical review

Utilization management

BH knowledge

Prior authorization

Discharge planning

Education

Bachelor's degree in nursing

Master's degree in behavioral health

LCSW license

LMHC license

LPC license

LMFT license

LMHP license

RN license

Job description

Centene Corporation seeks a behavioral health clinical reviewer to conduct comprehensive BH reviews for inpatient and outpatient settings. This fully remote role supports Oregon Medicaid with a weekday schedule 8–5 PT.

Applicants with independent licensure and BH utilization review experience are preferred. Master’s in behavioral health is required, and multiple BH licenses are listed as acceptable credentials.