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Utilization Review Clinician - Behavioral Health

Centene Corporation

Kansas

Remote

Full time

2 days ago

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Job summary

Centene Corporation seeks a Utilization Review Clinician specializing in Behavioral Health. In this role, you will assess treatment plans for mental health and substance abuse, conducting reviews and collaborating with healthcare teams to ensure quality of care. Competitive salary and flexible working arrangements available, with required licensure in Indiana or a compact RN license.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Qualifications

Graduate of an Accredited School Nursing or Bachelor's degree required.
2-4 years of related experience preferred.
Licensure as outlined by state requirements necessary.

Responsibilities

Performs clinical review and assesses care related to mental health and substance abuse.
Evaluates member’s treatment and performs prior authorization reviews.
Engages with medical directors and leadership to improve care quality.

Skills

Clinical knowledge and ability to review treatment plans related to mental health

Experience working with providers and healthcare teams

Education

Bachelor's degree in Nursing or related field

Master’s degree for behavioral health clinicians

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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.

Applicants for this role have the flexibility to work remotely from their home anywhere in the Eastern or Central time zone, but must possess an Indiana LMHC license or have a compact RN license with previous behavioral health experience.**

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.

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 $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

Seniority level

Seniority level
Not Applicable

Employment type

Employment type
Full-time

Job function

Job function
Health Care Provider
Industries
Hospitals and Health Care and Insurance

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