Utilization Review Clinician - BH

Cenetene Corporation; Columbia (SC); Remote; USD 60,000 - 80,000; Full time

Job summary

Join a leading organization committed to transforming healthcare for millions. As a clinical professional in the Medical Management team, you'll evaluate and oversee mental health and substance abuse services, ensuring effective treatment and care delivery while enjoying flexible work options.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Qualifications

• 2-4 years related experience in mental health and substance abuse.
• License to practice independently or state required licensure.
• Ability to assess treatment plans and improve service utilization.

Responsibilities

• Evaluates treatment for mental health and substance abuse.
• Performs prior authorization and concurrent reviews.
• Provides education regarding utilization processes.

Skills

Clinical knowledge

Behavioral health treatment assessment

Utilization review

Interpersonal communication

Education

Master's degree for behavioral health clinicians

Graduate of an Accredited School of Nursing or Bachelor's degree

Job description

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.

****Applicants for this role have the flexibility to work remotely from their home anywhere in the Eastern time zone.****

**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.

+ 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: $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's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

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