Utilization Review Clinician - Behavioral Health

Centene Management Company LLC; Louisiana (MO); Hybrid; USD 40,000 - 66,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Management Company LLC in Louisiana seeks a qualified clinician to perform clinical reviews and assess care related to mental health and substance abuse. You will monitor level of care and determine whether services are medically appropriate.

The role requires an active Louisiana license, a nursing or behavioral health degree, and 2–4 years of related experience. You will participate in prior authorization reviews, inpatient BH reviews, and collaborate with providers and medical

Qualifications

• Graduate of an accredited nursing program or a bachelor's degree with 2–4 years of related experience.
• Active, unrestricted Louisiana licensure required (RN, LCSW, LMHC, LPC, LMFT, LMHP or LMHP).
• Master’s degree in behavioral health required for clinicians.
• Experience with mental health and substance abuse utilization review preferred.

Responsibilities

• Evaluates BH/SA treatment before, during, and after services to ensure medical appropriateness.
• Performs prior authorization reviews related to BH/SA to determine medical appropriateness.
• Performs concurrent review of BH inpatient to determine overall health, needs, and discharge planning.
• Analyzes BH member data to improve quality and appropriate utilization of services.
• Provides education to providers, members and families re BH utilization processes.
• Interacts with BH healthcare providers to discuss level of care and services.
• Engages with medical directors and leadership to improve quality and efficiency of care.
• Formulates and presents cases in staffing and integrated rounds.
• Performs other duties as assigned and complies with all policies and standards.

Skills

Clinical knowledge

Utilization review

Behavioral health

Provider education

Interdisciplinary collaboration

Education

Bachelor's degree

Master's degree in behavioral health

Tools

EMR systems

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 position requires candidates to reside in Louisiana and hold an active, unrestricted Louisiana license. The schedule is either Sunday through Thursday or Tuesday through Saturday, working 8:00 AM to 5:00 PM CST. Candidates must be able to consistently work one of these designated schedules.

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 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

About Centene

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.

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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.

Equal Opportunity

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.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.