Utilization Review Clinician - Behavioral Health

Centene Corp.; Missouri; À distance; USD 37 000 - 67 000; Plein temps

Avantages offerts par ce poste

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work (remote, hybrid, field,

Total compensation may include other;}

Résumé du poste

Centene seeks a licensed professional to perform clinical reviews of mental health and substance use services to ensure appropriate level of care are medically necessary.

Responsibilities include prior authorization, concurrent BH inpatient reviews, data analysis to improve utilization, and education for providers, members, and families. Licensure in applicable state is required; multiple BH licensure options are listed. Flexible work arrangements may be available.

Qualifications

• Graduate of an Accredited School Nursing or Bachelor's degree with 2–4 years of related experience.
• License to practice independently, and/or state required licensure as outlined by applicable state requirements.
• Master’s degree for behavioral health clinicians required.
• LCSW, LMHC, LPC, LMFT, LMHP, RN licensure or equivalent; for Fidelis Care additional licenses may be required.

Responsabilités

• Evaluate member’s treatment to ensure the level of care and services are medically appropriate.
• Perform prior authorization reviews for BH services to determine medical appropriateness.
• Conduct concurrent BH inpatient reviews and discharge planning.
• Analyze BH member data to improve quality and utilization of services.
• Educate providers, members, and families regarding BH utilization process.
• Collaborate with BH providers and medical directors to improve care quality and efficiency.
• Present cases in staffing and integrated rounds.
• Perform other duties as assigned.
• Comply with all policies and standards.

Connaissances

Clinical review

Behavioral health

Formation

Bachelor's degree

Master’s degree in behavioral health

Description du poste

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
• For Fidelis Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required

Pay Range:

• $27.02 - $48.55 per hour

Centene Mission:

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 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