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
🕒 September 14
Where this job comes from
Posted on Centene Corporation's careers page, not through a job board
First seen by Remote Rocketship September 14
Still open on Centene Corporation's site. Checked 4 hours ago.
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 clinical reviews and assess mental health and substance abuse care • Monitor and determine whether levels of care and services are medically appropriate • Evaluate member treatment before, during, and after services • Perform prior authorization reviews according to regulatory guidelines and criteria • Conduct concurrent reviews of behavioral health inpatient care, treatment needs, and discharge planning • Analyze behavioral health member data to improve quality and utilization • Educate providers, members, and families about the behavioral health utilization process • Discuss levels 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 • Comply with policies and standards • Perform other assigned duties
🎯 Requirements
• Graduate of an accredited school of nursing or Bachelor's degree and 2–4 years of related experience • License to practice independently and/or required state licensure • Master's degree for behavioral health clinicians required • Active Georgia Licensed Clinician or Compact Nursing License • Experience in behavioral health • LCSW, LMHC, LPC, LMFT, LMHP, or RN state/compact licensure required • Clinical knowledge and ability to review and/or assess mental health and substance abuse treatment plans preferred • Knowledge of mental health and substance abuse utilization review process preferred • Experience working with providers and healthcare teams to review mental health and substance abuse care services preferred • Computer savvy • Provider-facing experience • Sunday–Thursday availability, 8:00 AM–5:00 PM, with rotating holidays and weekends
🏖️ Benefits
• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity
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