Utilization Review Clinician - Behavioral Health

Centene Corporation; Arkansas; On-site; USD 10,000 - 60,000; Full time

Job summary

A leading healthcare organization is seeking a Utilization Review Clinician specializing in Behavioral Health. This role involves performing clinical reviews, assessing care for mental health and substance abuse, and ensuring services are medically appropriate. Candidates must have a relevant degree and state licensure, with a strong background in clinical assessments and utilization review processes.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work options

Qualifications

• Graduate of an accredited school with Nursing or Bachelor's degree.
• 2–4 years of related experience required.
• License to practice independently.

Responsibilities

• Performs clinical reviews and assesses care related to mental health.
• Monitors and determines if level of care is medically appropriate.
• Provides education to providers, members, and families regarding BH utilization process.

Skills

Clinical knowledge

Assessment of treatment plans

Mental health utilization review

Interpersonal communication

Education

Bachelor's degree

Master’s degree in behavioral health

Job description

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You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Hours: Monday–Friday, 8:00 AM to 5:00 PM CST (CST time zone preferred)

Requirements: Outpatient experience preferred.

Position Purpose

Performs clinical reviews and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services are medically appropriate.

• Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate.
• Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria.
• Performs concurrent review of behavioral health inpatient to determine overall health of member, treatment needs, and discharge planning.
• Analyzes BH member data to improve quality and appropriate utilization of services.
• Provides education to providers, members, and their families regarding BH utilization process.
• Interacts with BH healthcare providers as appropriate to discuss level of care and/or services.
• Engages with medical directors and leadership to improve the quality and efficiency of care.
• Formulates and presents cases in staffing and integrated rounds.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience

Requires a graduate of an accredited school with a Nursing or Bachelor's degree and 2–4 years of related experience. License to practice independently, and/or have obtained the state-required licensure as outlined by the applicable state.

Master’s degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.

License/Certification

• LCSW - Licensed Clinical Social Worker required or
• LMHC - Licensed Mental Health Counselor required or
• LPC - Licensed Professional Counselor required or
• LMFT - Licensed Marital and Family Therapist required or
• LMHP - Licensed Mental Health Professional required or
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.

Pay Range: $26.50 - $47.59 per hour.

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work options including remote, hybrid, field, or office schedules. Actual pay will be adjusted based on skills, experience, education, and other factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by law. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.