Utilization Review Clinician – Behavioral Health

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Perform clinical reviews and assess care related to mental health and substance abuse • Monitor and determine whether level of care and services are medically appropriate • Perform medical necessity reviews and authorization determinations for inpatient and outpatient Behavioral Health Medicare Plan services • Evaluate member treatment before, during, and after services • Perform prior authorization reviews in accordance with regulatory guidelines and criteria • Perform concurrent review of behavioral health inpatient care, including member health, treatment needs, and discharge planning • Analyze behavioral health member data to improve quality and appropriate utilization • Educate providers, members, and families about the behavioral health utilization process • Discuss level of care and services with behavioral health healthcare providers • Engage medical directors and leadership to improve care quality and efficiency • Formulate and present cases in staffing and integrated rounds • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Graduate of an Accredited School Nursing or Bachelor's degree and 2–4 years of related experience • License to practice independently and/or state-required licensure • Master's degree for behavioral health clinicians required • LCSW (Licensed Clinical Social Worker) required, or LMHC (Licensed Mental Health Counselor) required, or LPC (Licensed Professional Counselor) required, or LMFT (Licensed Marital and Family Therapist) required, or LMHP (Licensed Mental Health Professional) required, or RN (Registered Nurse) state licensure and/or compact state licensure 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 • Monday–Friday availability, 8:00 AM–5:00 PM EST

🏖️ Benefits

• Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Competitive pay • Additional forms of incentives may be included in total compensation