Utilization Review Clinician - Behavioral Health

Centene Corp.; Georgia; Remote; USD 37,000 - 67,000; Full time

Job summary

Centene Corp. is seeking a Utilization Review Clinician - Behavioral Health for a remote role in Georgia. Candidates must hold an active Georgia licensed clinician or compact nursing license and have BH experience.

The role runs Monday–Friday 8:00 AM to 5:00 PM with rotating holidays and weekends, and involves prior authorizations, concurrent reviews, and education of providers and families. The ideal candidate has strong communication, organizational skills, and knowledge of BH utilization

Qualifications

• Graduate or RN with a bachelor’s degree and 2–4 years of related experience.
• Master’s degree in behavioral health is required for clinicians.
• Georgia licensure or compact license to practice.

Responsibilities

• Evaluate BH member treatment to ensure level of care is appropriate.
• Perform prior authorization reviews for mental health and substance use.
• Conduct concurrent BH inpatient reviews and discharge planning.
• Educate providers, members and families on BH utilization processes.
• Interact with BH providers and discuss level of care and services.
• Present cases in staffing and integrated rounds.
• Comply with all policies and standards.

Skills

Excellent communication

Customer service

Computer skills

Provider-facing experience

Organizational skills

Regulatory knowledge

Education

Bachelor's degree

Graduate of an Accredited School Nursing

Master’s degree in behavioral health

Job description

## Utilization Review Clinician - Behavioral HealthApply: Remote-GA: Full time: Posted Today: 1658549**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 is a remote position; however, applicants must hold an active Georgia Licensed Clinician or Compact Nursing License. Candidates must have experience in behavioral health. The ideal candidate is computer savvy, has provider-facing experience, demonstrates excellent communication and customer service skills, is highly organized, and can quickly adapt to change. The work schedule is Monday through Friday, 8:00 AM to 5:00 PM, with rotating holidays and weekends.* 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 requiredPay Range: $27.02 - $48.55 per hour