Utilization Review Clinician - Behavioral Health

Centene Corporation; Raleigh (NC); Remote; USD 60,000 - 80,000; Full time

Job summary

A national healthcare organization is seeking a clinical professional for a remote role in Medical Management. You will assess mental health and substance abuse services, ensuring appropriateness and compliance. Candidates must have North Carolina licensure and a Master’s degree in behavioral health. Competitive pay ranging from $26.50 to $47.59 per hour, along with comprehensive benefits, is offered.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Qualifications

• 2-4 years of related experience in mental health.
• Licensure required: LCSW, LMHC, LPC, LMFT, LMHP, and RN state licensure.
• Knowledge of care services related to mental health and substance abuse.

Responsibilities

• Evaluates member’s treatment to ensure medical appropriateness.
• Performs prior authorization reviews for mental health services.
• Analyzes BH member data to enhance service quality.

Skills

Clinical knowledge related to mental health

Experience with utilization review process

Interpersonal skills to engage with healthcare providers

Education

Master’s degree for behavioral health clinicians

Graduate of an Accredited School Nursing

Job description

Overview

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

POSITION IS REMOTE WITH POTENTIAL FOR WEEKEND AND HOLIDAY ROTATIONS

MUST HOLD NORTH CAROLINA BEHAVIORAL HEALTH LICENSURE

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.

Responsibilities

• Evaluates member\u2019s 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 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\u2019s 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\u2019s 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 - Licensed Clinical Social Worker required
• LMHC - Licensed Mental Health Counselor required
• LPC - Licensed Professional Counselor required
• Licensed Marital and Family Therapist (LMFT) required
• Licensed Mental Health Professional (LMHP) required
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range: $26.50 - $47.59 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual\u2019s 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