Utilization Review Clinician - Behavioral Health

Centene Corporation; Salem (OR); Remote; USD 37,000 - 66,000; Full time

Benefits offered by this job

Remote work option

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Corporation seeks a behavioral health clinical reviewer to conduct comprehensive BH reviews for inpatient and outpatient settings. This fully remote role supports Oregon Medicaid with a weekday schedule 8–5 PT.

Applicants with independent licensure and BH utilization review experience are preferred. Master’s in behavioral health is required, and multiple BH licenses are listed as acceptable credentials.

Qualifications

• Requires graduate of an accredited nursing school or bachelor’s degree with 2–4 years related experience.
• State licensure to practice independently; master’s degree in behavioral health clinicals preferred.
• Licenses (LCSW, LMHC, LPC, LMFT, LMHP, RN) are required.
• Experience with providers and healthcare teams to review care for mental health/substance use disorders preferred.

Responsibilities

• Evaluates member’s treatment for mental health and substance abuse to ensure medical appropriateness.
• Performs prior authorization reviews for BH services as per guidelines.
• Performs concurrent BH inpatient reviews and discharge planning.
• Analyzes BH data to improve quality and utilization of services.
• Educates providers, members, and families on BH utilization processes.
• Interacts with BH providers and medical directors to improve care quality and efficiency.
• Presents cases in staffing and integrated rounds.
• Performs other duties as assigned.
• Complies with policies and standards.

Skills

Clinical review

Utilization management

BH knowledge

Prior authorization

Discharge planning

Education

Bachelor's degree in nursing

Master's degree in behavioral health

LCSW license

LMHC license

LPC license

LMFT license

LMHP license

RN license

Job description

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 Oregon Medicaid by conducting behavioral health clinical reviews for both inpatient and outpatient levels of care. The schedule is Monday through Friday, 8-5 pm pacific time zone. Preference will be given to applicants in any United States time zone who have (1) independent clinical licensure, (2) prior behavioral health and (3) 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
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• 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

$27.02 - $48.55 per hour

About Centene

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.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• 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.

EEO / DEI

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.

Legal

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.