Utilization Review Clinician - Behavioral Health

Centene Management Company LLC; California; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K/Stock options

Tuition reimbursement

Paid time off & holidays

Job summary

Centene Corp. is seeking a licensed clinician to perform clinical reviews and assess mental health and substance use care for medical appropriateness.

The role supports the California market and is fully remote, with schedule options for CA residents and eligibility for non-CA applicants willing to accommodate training and core shifts. The candidate will evaluate treatment plans, perform prior authorization and concurrent BH reviews, and collaborate with providers and medical directors to ensure

Qualifications

• Graduate of an Accredited School Nursing or Bachelor's degree and 2–4 years of related experience.
• Master’s degree for behavioral health clinicians required.
• Clinical knowledge for reviewing mental health and substance abuse treatment plans.

Responsibilities

• Evaluates member’s mental health and substance abuse treatment for appropriateness.
• Performs prior authorization reviews for BH services.
• Conducts concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve utilization and quality.
• Educates providers, members, and families on BH utilization processes.
• Interacts with BH providers to discuss level of care and services.
• Collaborates with medical directors to improve care quality and efficiency.
• Presents cases in staffing and rounds.
• Performs additional duties per policy.

Skills

Clinical review

Utilization management

Care coordination

Provider education

Education

Accredited nursing program or Bachelor's degree

Master’s degree in behavioral health

Active clinical licensure (LCSW/LMHC/LPC/LMFT/LMHP/RN)

Job description

Position Purpose

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

Key Details

This fully remote role supports the California Market. Open to applicants in other states if they are able to the work the trainnig schedule (Monday through Friday 8-5 pm for the first few weeks) as well as one of the main schedule. Note this includes rotating holidays and occasional over time. The main schedule options for California Residents are either Thursday through Monday 930a-6p PT or Friday through Tuesday 930a-6p PT. The main schedule for non-California residents is Friday through Monday 730a-6p PT (w 30 min break for lunch). Preference will be given to applicants with behavioral health and utilization management or review experience.

Responsibilities

• 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 (BH) 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 regrading 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 Graduate of an Accredited School 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 required. 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- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range

Pay Range: $27.02 - $48.55 per hour

Company Overview

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.

Equal Opportunity Employer

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act