Centene Corporation
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.
Utilization Review Clinician – Behavioral Health
🔥 8 minutes ago
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Centene Corporation
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 medical necessity reviews and authorization determinations • Monitor and determine if level of care and services related to mental health and substance abuse are medically appropriate • Evaluate member’s treatment for mental health and substance abuse before, during, and after services • Perform prior authorization reviews related to mental health and substance abuse to determine medical appropriateness • Perform concurrent review of behavioral health (BH) inpatient • Analyze BH member data to improve quality and appropriate utilization of services • Provide education to providers, members, and their families regarding BH utilization process • Interact with BH healthcare providers and engage with medical directors and leadership to improve quality
🎯 Requirements
• Active RN license or independent clinical licensure (LCSW, LMHC, LMFT, LPC) • Behavioral health and/or utilization management experience preferred • Strong knowledge of medical necessity criteria and managed care principles • Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.
🏖️ Benefits
• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules
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