Utilization Review Clinician ?? Behavioral Health ?? Fully remote position with flexible work hours (Apply in minutes)
You could be the one who changes everything for our 28 million members as a
clinical professional on our Medical ManagementHealth Services team. Centene
is a diversified, national organization offering competitive benefits
including a fresh perspective on workplace flexibility.
***NOTE: This is a fully remote role for US based applicants with independent
clinical licensure. Preference will be given to applicants who reside in
either CST or EST time zone with experience in mental health settings and
utilization management review. ****
*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 andor 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
*EducationExperience:** Requires Graduate of an Accredited School Nursing or
Bachelors degree and 2 4 years of related experience.
License to practice independently, andor 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 andor 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.
*LicenseCertification:**
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 andor Compact State Licensure required
***Additional Details:
Department: IL Meridian Behavioral Health Utilization Management ****
Pay Range: $25.97 - $46.68 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
individuals 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
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