Utilization Review Clinician - Behavioral Health

Centene; New York (NY); 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 schedules (remote,hybrid

Résumé du poste

Centene seeks an Utilization Review Clinician - Behavioral Health for a fully remote role serving New York. You will perform clinical reviews, assess care levels, and authorize mental health/substance abuse services.

Requires a clinical license (RN or LMSW/LCSW/LMHC/LPC/LMFT/LMHP) and a bachelor’s degree with 2–4 years of related experience. The role emphasizes education for providers and members, collaboration with medical directors, and ensuring medical appropriateness of care in a day-shift,

Qualifications

• Bachelor's degree required or graduation from an accredited school of nursing.
• Licensure options include LMSW, LCSW, LMHC, LPC, LMFT, LMHP, or RN.
• 2–4 years of related experience preferred.

Responsabilités

• Evaluate member’s treatment for mental health and substance abuse to ensure medical appropriateness.
• Perform prior authorization reviews related to mental health and substance abuse.
• Conduct concurrent reviews of behavioral health inpatient cases.
• Analyze behavioral health member data to improve service utilization.
• Provide education to providers, members, and families regarding the behavioral health utilization process.
• Interact with behavioral health healthcare providers to discuss levels of care.
• Engage with medical directors and leadership to enhance care quality and efficiency.
• Formulate and present cases in staffing and integrated rounds.

Formation

Bachelor's degree

Nursing degree

Description du poste

About This Role

The Utilization Review Clinician - Behavioral Health performs clinical reviews and assessments related to mental health and substance abuse, ensuring that the level of care and services provided are medically appropriate. This fully remote position is ideal for candidates with a strong clinical background and relevant licensure.

Highlights

• Pay: $27.02 - $48.55 per hour
• Location: Remote, NY
• Schedule: Full Time, Day shift

What You'll Do

• Evaluate member’s treatment for mental health and substance abuse to ensure medical appropriateness.
• Perform prior authorization reviews related to mental health and substance abuse.
• Conduct concurrent reviews of behavioral health inpatient cases.
• Analyze behavioral health member data to improve service utilization.
• Provide education to providers, members, and families regarding the behavioral health utilization process.
• Interact with behavioral health healthcare providers to discuss levels of care.
• Engage with medical directors and leadership to enhance care quality and efficiency.
• Formulate and present cases in staffing and integrated rounds.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements

• Education:
• Graduation from an accredited school of nursing or a bachelor’s degree required.
• Experience:
• 2–4 years of related experience preferred.
• Licenses & Certifications:
• One of the following licenses required: LMSW, LCSW, LMHC, LPC, LMFT, LMHP, or RN.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules (remote, hybrid, field, or office)

About Centene

Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, making a real impact every day through meaningful challenges and a dedicated team.