Utilization Review Clinician - Behavioral Health

Centene Corporation; Washington; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene Corporation is seeking a remote Behavioral Health RN reviewer to assess care related to mental health and substance use disorders. You will participate in weekend/holiday rotations and must hold an RN license active in Washington or a compact state.

You will evaluate care plans, perform prior authorizations, and collaborate with medical directors to ensure appropriate services, quality, and outcomes for members across programs.

Qualifications

• Graduate of an Accredited School Nursing or Bachelor’s degree with 2–4 years of related experience.
• State licensure to practice independently as outlined by state requirements.
• Master’s degree in behavioral health required for clinicians.

Responsibilities

• Evaluate member’s treatment for mental health and substance abuse to ensure appropriate level of care.
• Perform prior authorization reviews per regulatory guidelines.
• Conduct concurrent review of BH inpatient stays and discharge planning.
• Analyze BH data to improve service quality and utilization.
• Educate providers, members and families on BH utilization processes.

Skills

Clinical review

Behavioral health

Policy compliance

Team collaboration

Education

Master’s in behavioral health

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 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.

• 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 or
• LMHC-Licensed Mental Health Counselor required or
• LPC-Licensed Professional Counselor required or
• Licensed Marital and Family Therapist (LMFT) required or
• Licensed Mental Health Professional (LMHP) required or
• 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.

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