Utilization Review Clinician – Behavioral Health

🔥 3 minutes ago

☕ Washington – Remote

☕ Washington – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

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

• 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 • 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 • Engages with medical directors and leadership to improve the quality and efficiency of care • Formulates and presents cases in staffing and integrated rounds

🎯 Requirements

• Graduate of an Accredited School Nursing or Bachelor's degree • 2 – 4 years of related experience • Must be licensed in state of WA • 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

🏖️ 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