Utilization Review Clinician - Behavioral Health

Cenetene Corporation; Jefferson City (MO); Remote; Full time

Job summary

An established industry player is seeking a dedicated clinical professional to join their Medical Management/Health Services team. This remote role offers the chance to impact the lives of 28 million members by conducting clinical reviews and assessments related to mental health and substance abuse. You will engage with healthcare providers, analyze member data, and ensure the quality and appropriateness of care. With a comprehensive benefits package and a flexible work environment, this position is perfect for those looking to make a difference in the healthcare field while enjoying a supportive workplace culture.

Benefits

Health Insurance

401K Plan

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• Graduate of an accredited nursing school or Bachelor's degree with 2-4 years of experience.
• Master's degree required for behavioral health clinicians.

Responsibilities

• Evaluates treatment for mental health and substance abuse to ensure appropriateness.
• Performs prior authorization reviews and concurrent reviews for BH inpatient.

Skills

Clinical Review

Mental Health Assessment

Substance Abuse Knowledge

Treatment Plan Review

Data Analysis

Provider Education

Education

Bachelor's Degree

Master's Degree in Behavioral Health

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 IS REMOTE BUT CANDIDATE MUST RESIDE IN MISSOURI AND HOLD MISSOURI LICENSURE*****

*****CANDIDATE WILL WORK UP TO 4 HOLIDAYS A YEAR WITH THIS ROLE*****

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.

1. 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.
2. Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria.
3. Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning.
4. Analyzes BH member data to improve quality and appropriate utilization of services.
5. Provides education to providers, members, and their families regarding BH utilization process.
6. Interacts with BH healthcare providers as appropriate to discuss level of care and/or services.
7. Engages with medical directors and leadership to improve the quality and efficiency of care.
8. Formulates and presents cases in staffing and integrated rounds.
9. Performs other duties as assigned.
10. 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:

1. LCSW - License Clinical Social Worker required
2. LMHC - Licensed Mental Health Counselor required
3. LPC - Licensed Professional Counselor required
4. Licensed Marital and Family Therapist (LMFT) required
5. Licensed Mental Health Professional (LMHP) required
6. RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range: $26.50 - $47.59 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. Total compensation may also include additional forms of incentives.

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.