Utilization Review Clinician—Mental Health & Substance Use

Centene Corporation; Louisiana (MO); Hybrid; USD 37.000 - 67.000; Vollzeit

Benefits dieser Stelle

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Zusammenfassung

Centene Corporation seeks a clinical reviewer to assess care for mental health and substance use, ensuring level of care and medical appropriateness across services.

The role requires Louisiana licensure, a nursing or behavioral health credential, and 2–4 years of related experience. Work schedules follow 8:00 AM–5:00 PM CST on Sunday-Thursday or Tuesday-Saturday.

This position supports provider education, care coordination, and utilization review within a collaborative team.

Qualifikationen

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

Aufgaben

• 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.
• Performs concurrent review of behavioral health inpatient to determine overall health and discharge planning.
• Analyzes BH member data to improve quality and appropriate utilization of services.
• Provides education to providers, members, and families regrading BH utilization process.
• Interacts with BH healthcare providers to discuss level of care and/or services.
• Engages with medical directors and leadership to improve quality and efficiency of care.
• Formulates and presents cases in staffing and integrated rounds.
• Performs other duties as assigned.

Kenntnisse

Clinical review

Utilization review

Interdisciplinary collaboration

Education providers/families

Ausbildung

Bachelor's degree

Master’s degree in behavioral health

Jobbeschreibung

Centene Corporation seeks a clinical reviewer to assess care for mental health and substance use, ensuring level of care and medical appropriateness across services.

The role requires Louisiana licensure, a nursing or behavioral health credential, and 2–4 years of related experience. Work schedules follow 8:00 AM–5:00 PM CST on Sunday-Thursday or Tuesday-Saturday.

This position supports provider education, care coordination, and utilization review within a collaborative team.