Centene Corporation
Utilization Review Clinician - Behavioral Health
Centene Corporation, Houston, Texas, United States
Remote Position. Must Reside in Hawaii. Registered Nurse (RN) or Licensed Clinician Only. Must have a current state’s license.
Must have Behavioral Health and Substance Abuse experience. Utilization Management experience strongly preferred.
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.
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 regarding 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 - Licensed Clinical Social Worker required
LMHC - Licensed Mental Health Counselor required
LPC - Licensed Professional Counselor required
LMFT - Licensed Marital and Family Therapist required
LMHP - Licensed Mental Health Professional required
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
For Fidelis Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required
Pay Pay Range $26.50 – $47.59 per hour.
Benefits Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) 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.
Equal Opportunity 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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Must have Behavioral Health and Substance Abuse experience. Utilization Management experience strongly preferred.
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.
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 regarding 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 - Licensed Clinical Social Worker required
LMHC - Licensed Mental Health Counselor required
LPC - Licensed Professional Counselor required
LMFT - Licensed Marital and Family Therapist required
LMHP - Licensed Mental Health Professional required
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
For Fidelis Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required
Pay Pay Range $26.50 – $47.59 per hour.
Benefits Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) 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.
Equal Opportunity 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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