Utilization Review Clinician - Behavioral Health

Centene Corporation; California (MO); Remote; USD 37,222 - 66,882; Full time

Benefits offered by this job

Comprehensive benefits package

Flexible work schedule

Tuition reimbursement

401K and stock purchase plans

Paid time off and holidays

Job summary

A diversified national organization is seeking a Licensed Clinical Behavioral Health Professional or RN to assess care related to mental health and substance abuse. This role involves evaluating treatment needs, performing authorization reviews, and improving service quality. Ideal candidates should have strong behavior health experience and a relevant license. This position offers competitive pay, a flexible work schedule, and a comprehensive benefits package including health insurance and paid time off.

Qualifications

• Licensed Clinical Behavioral Health Professional or RN.
• Must reside in California.
• Experience in mental health and substance abuse.

Responsibilities

• Evaluate treatment for mental health and substance abuse.
• Perform prior authorization reviews.
• Analyze BH member data for quality improvement.
• Engage with healthcare providers on care levels.

Skills

Behavior Health experience

Clinical knowledge of mental health

Experience working with providers

Education

Bachelor's degree

Graduate of an Accredited School Nursing

Master’s degree for behavioral health clinicians

Job description

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.

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.

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 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

We are seeking a Licensed Clinical Behavioral Health Professional or RN to join our team!

The ideal candidate will bring expertise in

• Licensed Clinical Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMHC, LPC, LMFT, LMHP and RN with BH experience
• Strong Behavior Health experience
• Must reside in CA

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

Pay Range $27.02 - $48.55 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 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.

Seniority level

• Not Applicable

Employment type

• Full-time

Job function

• Health Care Provider
• Hospitals and Health Care and Insurance

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.