Utilization Review Clinician - Behavioral Health

Centene Corporation; Orlando (FL); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Utilization Review Clinician specializing in Behavioral Health. This remote role requires a licensed professional in Florida to evaluate treatment and ensure appropriate care levels for mental health and substance abuse. Candidates should have a Master's degree and relevant experience. The position offers competitive pay and comprehensive benefits.

Benefits

Comprehensive Benefits Package

Competitive Pay

Flexible Work Arrangements

Qualifications

• 2-4 years of related experience required.
• Knowledge of mental health and substance abuse review processes preferred.

Responsibilities

• Evaluate member’s treatment for mental health and substance abuse.
• Perform prior authorization reviews.
• Conduct concurrent review of inpatient behavioral health.

Skills

Mental Health

Substance Abuse

Data Analysis

Education

Master’s Degree

Bachelor's Program

Job description

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This role offers the opportunity to make a difference for our 28 million members as a clinical professional in our Medical Management/Health Services team. Centene is a diversified, national organization that provides competitive benefits and promotes workplace flexibility.

Position Purpose

Performs clinical reviews and assesses care related to mental health and substance abuse, ensuring that levels of care and services are medically appropriate.

Responsibilities

1. Evaluate member’s treatment for mental health and substance abuse throughout the care process.
2. Perform prior authorization reviews in accordance with regulatory guidelines.
3. Conduct concurrent review of inpatient behavioral health to determine treatment needs and discharge planning.
4. Analyze data to improve quality and utilization of services.
5. Provide education to providers, members, and families regarding BH utilization.
6. Engage with healthcare providers to discuss care levels and services.
7. Collaborate with medical directors and leadership to enhance care quality and efficiency.
8. Present cases in staffing and rounds.
9. Perform other duties as assigned and ensure policy compliance.

This is a remote position; candidates must be licensed and based in Florida.

Ideal Candidates

Hold an LCSW, LMFT, or LMHC license.

Education & Experience

Graduate of an accredited nursing or bachelor's program with 2-4 years of related experience. Master’s degree required for behavioral health clinicians. Knowledge of mental health and substance abuse review processes is preferred.

Licenses & Certifications

• LCSW, LMHC, LPC, LMFT, LMHP, or RN licensure required.

We offer a comprehensive benefits package, competitive pay, and flexible work arrangements. Salary is commensurate with experience and qualifications.

Additional Information

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.