Utilization Review Clinician - Behavioral Health

Centene Corporation; Seattle (WA); Remote; USD 37,000 - 66,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote/hybrid/field or office work

Job summary

Centene Corporation is seeking a skilled clinician to perform clinical reviews and assess care for mental health and substance use. This remote role requires an active Washington RN or Compact RN license and offers weekday hours with weekend/holiday rotation.

You will evaluate treatment plans, authorize BH services, participate in rounds, educate providers and families, and collaborate with medical directors to improve quality and efficiency.

Qualifications

• RN license required; active license to practice
• Master’s degree for behavioral health clinicians preferred
• Clinical knowledge to review treatment plans for mental health/substance abuse
• Experience working with providers/teams on care review preferred

Responsibilities

• Evaluates treatment for mental health/substance abuse before, during, and after services
• Performs prior authorization reviews for medical appropriateness
• Performs concurrent review of BH inpatient care
• Analyzes BH data to improve quality and utilization
• Educates providers, members and families on BH utilization process
• Interacts with BH providers to discuss level of care/services
• Engages with medical directors to improve care quality/efficiency
• Presents cases in staffing and rounds
• Performs other duties and adheres to policies

Skills

RN license

BH clinical knowledge

Utilization review

Education

Bachelor's degree in nursing

Master's degree in behavioral health

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 is a remote position working Monday through Friday, 8:00 AM to 5:00 PM PST. Candidates must be available to participate in weekend and holiday rotation schedules. An active Washington RN license or active Compact RN license is required.

Key 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: $27.02 - $48.55 per hour

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.

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.