Remote Utilization Review Clinician – Mental Health

Centene Corp.; Kansas; Remote; USD 37,000 - 67,000; Full time

Benefits offered by this job

Remote work options

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Corp. is seeking a remote Behavioral Health Utilization Reviewer to assess mental health and substance abuse care, perform prior authorization, and drive quality improvement. The role follows a Mon-Fri 8-5 schedule across ET/CT/PT time zones with collaboration across providers and leadership.

Preference will be given to independent BH clinicians (LCSW/LMHC/LCPC/LMFT) and those with outpatient or residential experience, utilization management, and leadership presentations.

Qualifications

• Requires graduate of an accredited school and/or bachelor's degree.
• 2–4 years of related experience.
• License to practice independently or state licensure as applicable.
• Master’s degree for behavioral health clinicians preferred.

Responsibilities

• Evaluates member mental health and substance abuse treatment for appropriate level of care.
• Performs prior authorization reviews for behavioral health services.
• Conducts concurrent review of BH inpatient care and discharge planning.
• Analyzes BH data to improve quality and utilization of services.
• Educates providers and families on BH utilization process.
• Interacts with BH providers and leadership to discuss care decisions and improvements.

Skills

BH clinical review

Utilization management

Provider coaching

Data presentation

Education

Bachelor's degree in nursing or related

Master's degree in behavioral health

Job description

Centene Corp. is seeking a remote Behavioral Health Utilization Reviewer to assess mental health and substance abuse care, perform prior authorization, and drive quality improvement. The role follows a Mon-Fri 8-5 schedule across ET/CT/PT time zones with collaboration across providers and leadership.

Preference will be given to independent BH clinicians (LCSW/LMHC/LCPC/LMFT) and those with outpatient or residential experience, utilization management, and leadership presentations.