Utilization Review Clinician - Behavioral Health

Centene; California (MO); On-site; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K plans

Tuition reimbursement

Paid time off

Job summary

Centene is hiring a Utilization Review Clinician - Behavioral Health for a fully remote position, serving members nationwide with a focus on mental health and substance abuse utilization management. The role emphasizes clinical reviews, prior authorizations, and data-driven care improvement.

Requirements include a nursing or related degree, a Master\'s in behavioral health, and 2–4 years of relevant experience with licensure options such as LCSW/LMHC/LPC/LMFT/LMHP or RN.

Qualifications

• Bachelor's degree required; Master's degree in behavioral health required for clinicians.
• 2-4 years of related experience preferred.
• Licenses: LCSW, LMHC, LPC, LMFT, LMHP, or RN licensure required.

Responsibilities

• Evaluate mental health and substance abuse treatment for medical appropriateness.
• Perform prior authorization reviews for mental health and substance use services.
• Conduct concurrent reviews of behavioral health inpatient cases.
• Analyze behavioral health data to improve service utilization.
• Educate providers, members, and families on the utilization process.
• Collaborate with medical directors and leadership to improve care quality.
• Present cases in staffing and integrated rounds.
• Adhere to policies and standards.

Skills

Behavioral health

Utilization management

Clinical reviews

Education

Bachelor's degree

Master's degree in behavioral health

Job description

About This Role

The Utilization Review Clinician - Behavioral Health performs clinical reviews and assessments related to mental health and substance abuse, ensuring that care levels and services are medically appropriate. This fully remote position is ideal for those with experience in behavioral health and utilization management.

Highlights

• Pay: $27.02 - $48.55/hour
• Location: Remote, CA
• Schedule: Full Time, Day shift

What You'll Do

• Evaluate member's treatment for mental health and substance abuse to ensure medical appropriateness.
• Perform prior authorization reviews related to mental health and substance abuse.
• Conduct concurrent reviews of behavioral health inpatient cases.
• Analyze behavioral health member data to improve service utilization.
• Provide education to providers, members, and families regarding the behavioral health utilization process.
• Interact with behavioral health healthcare providers to discuss care levels and services.
• Engage with medical directors and leadership to enhance care quality and efficiency.
• Formulate and present cases in staffing and integrated rounds.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements

Education

• Graduate of an Accredited School of Nursing or Bachelor's degree required
• Master's degree for behavioral health clinicians required

Experience

• 2-4 years of related experience preferred

Licenses & Certifications

One of the following licenses required:

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

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules (remote, hybrid, field, or office)

About Centene

Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, making a real impact every day through meaningful challenges and a dedicated team.