Utilization Review Clinician - Behavioral Health

Centene Corporation; Sacramento (CA); Remoto; USD 37.000 - 68.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Descrizione del lavoro

Centene Corporation offers a fully remote clinical reviewer position focused on mental health and substance use care within the California Market. The role requires evaluating care, conducting prior authorizations, and coordinating with providers across states with Pacific time scheduling.

Qualifications include nursing or related bachelor’s degree and master’s level behavioral health training, with licenses to practice.

Competenze

• Clinical knowledge to review and assess treatment plans.
• Experience with mental health and substance use utilization review preferred.
• Ability to work with providers and healthcare teams.

Mansioni

• Evaluates treatment for mental health and substance use to ensure medically appropriate level of care.
• Performs prior authorization reviews for BH services.
• Performs concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve utilization and quality.
• Educates providers, members, and families on BH utilization processes.
• Interacts with BH healthcare providers and medical leadership to improve care quality.

Conoscenze

Clinical review

Utilization management

Healthcare collaboration

Formazione

Bachelor's degree in Nursing or related field

Master's degree in Behavioral Health

Descrizione del lavoro

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.

Key Details

This fully remote role supports the California Market. Open to applicants in other states if they are able to the work the schedule: Monday through Friday, 9-6 pm or 9:30am - 6pm pacific time zone (depending on lunch) with rotating holidays and occasional over time. Preference will be given to applicants with behavioral health and utilization management or review experience.

Responsibilities

• 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
• 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

Pay Range: $27.02 - $48.55 per hour

About Us

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.

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’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