Utilization Review Clinician - Behavioral Health

Centene Corporation; California City (CA); Remote; USD 37,000 - 67,000; Full time

Job summary

Centene Corporation is seeking a remote Behavioral Health/Utilization Review professional to support the California Market. The role requires nursing or bachelor’s degree with 2–4 years of related experience and appropriate behavioral health licensure.

The position offers a full-time schedule (Mon–Fri, Pacific time) with potential overtime and holidays. Strong knowledge of regulatory guidelines is preferred and prior authorization experience is valued.

Qualifications

• Requires nursing or bachelor’s degree with 2–4 years of related experience.
• Master’s degree in behavioral health preferred for clinicians.
• Licensure as specified (LCSW/LMHC/LPC/LMFT/LMHP/RN) required or obtained.

Responsibilities

• Performs clinical review and assesses care related to mental health and substance abuse.
• Performs prior authorization reviews for BH/SA to determine medical appropriateness.
• Performs concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve quality and utilization of services.
• Provides education to providers, members and families re BH utilization.
• Engages with medical directors to improve quality and efficiency of care.

Skills

Behavioral health utilization

Clinical review

Provider education

Regulatory guidelines

Education

Graduate of an Accredited School of Nursing or Bachelor's degree

Master's degree in behavioral health (preferred)

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 schedule: Monday through Friday, 9-6 pm or 9:30am - 6pm pacific time zone (depending on lunch) with rotating holidays and occasional over time. Preference will be given to applicants with behavioral health and utilization management or review experience.

• 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: $27.02 - $48.55 per hour

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 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