Centene Corporation
Utilization Review Clinician - Behavioral Health
Centene Corporation, Florida, New York, United States
Utilization Review Clinician - Behavioral Health
Company:
Centene Corporation
Job Type:
Full-time, Remote (potential weekends and holidays)
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 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 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
Graduate of an accredited nursing school or Bachelor’s degree with 2–4 years related experience.
Master’s degree for behavioral health clinicians required.
License to practice independently and/or state-required licensure.
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.
Licenses & Certifications
LCSW – Licensed Clinical Social Worker
LMHC – Licensed Mental Health Counselor
LPC – Licensed Professional Counselor
LMFT – Licensed Marital and Family Therapist
LMHP – Licensed Mental Health Professional
RN – Registered Nurse with state licensure and/or Compact State Licensure
For Fidelis Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required.
Pay &3> Pay Range: $27.02 – $48.55 per hour. Benefits include competitive pay, health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office schedules.
Equal Opportunity Employer 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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Centene Corporation
Job Type:
Full-time, Remote (potential weekends and holidays)
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 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 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
Graduate of an accredited nursing school or Bachelor’s degree with 2–4 years related experience.
Master’s degree for behavioral health clinicians required.
License to practice independently and/or state-required licensure.
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.
Licenses & Certifications
LCSW – Licensed Clinical Social Worker
LMHC – Licensed Mental Health Counselor
LPC – Licensed Professional Counselor
LMFT – Licensed Marital and Family Therapist
LMHP – Licensed Mental Health Professional
RN – Registered Nurse with state licensure and/or Compact State Licensure
For Fidelis Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required.
Pay &3> Pay Range: $27.02 – $48.55 per hour. Benefits include competitive pay, health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office schedules.
Equal Opportunity Employer 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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