Utilization Review Clinician - Behavioral Health

Centene; Oregon; Remote; USD 56,000 - 101,000; 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 schedules

Job summary

Centene is seeking a remote Utilization Review Clinician - Behavioral Health to support Oregon Medicaid. The role requires independent clinical licensure and experience in behavioral health and utilization management.

It offers a full-time day-shift schedule and a nationwide remote work option within Oregon Medicaid guidelines. The candidate should have a graduate degree in nursing or a relevant field, plus a master's in behavioral health, and 2–4 years of related experience.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree required.
• Master's degree required for behavioral health clinicians.

Responsibilities

• Evaluate member's treatment for mental health and substance abuse before, during, and after services.
• 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 behavioral health utilization processes.
• Interact with behavioral health healthcare providers to discuss levels of care and services.
• Engage with medical directors and leadership to enhance care quality and efficiency.

Education

Bachelor's degree

Master's degree in behavioral health

Job description

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 role supports Oregon Medicaid and is ideal for candidates with independent clinical licensure and experience in behavioral health and utilization management.

Highlights

• Pay: $27.02 - $48.55/hour
• Location: Remote, OR
• Schedule: Full-time, Day shift

What You'll Do

• Evaluate member's treatment for mental health and substance abuse before, during, and after services.
• 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 behavioral health utilization processes.
• Interact with behavioral health healthcare providers to discuss levels of care and services.
• 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:

• Graduate of an Accredited School of Nursing or Bachelor's degree required
• Master's degree for behavioral health clinicians required

Experience:

• 2 - 4 years of related experience preferred
• Clinical knowledge and ability to review treatment plans related to mental health and substance abuse preferred
• Experience working with providers and healthcare teams preferred

Licenses & Certifications:

One of the following licenses required:

• LCSW (Licensed Clinical Social Worker)
• LMHC (Licensed Mental Health Counselor)
• LPC (Licensed Professional Counselor)
• LMFT (Licensed Marital and Family Therapist)
• LMHP (Licensed Mental Health Professional)
• RN (Registered Nurse) - State Licensure and/or Compact State Licensure required

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 work)

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 that support individuals, families, and communities.