Utilization Review Clinician – Behavioral Health
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Job Description
Behavioral health utilization review clinician assessing mental health and substance abuse care for Centene. Conducting authorizations, concurrent reviews, and provider education remotely in Florida.
Responsibilities:
- Perform clinical reviews and assess care related to mental health and substance abuse
- Monitor and determine whether levels of care and services are medically appropriate
- Evaluate member treatment before, during, and after services
- Perform prior authorization reviews in accordance with regulatory guidelines and criteria
- Perform concurrent reviews of behavioral health inpatient care, including member health, treatment needs, and discharge planning
- Analyze behavioral health member data to improve quality and appropriate utilization of services
- Educate providers, members, and families regarding the behavioral health utilization process
- Interact with behavioral health healthcare providers to discuss levels of care and services
- Engage with medical directors and leadership to improve care quality and efficiency
- Formulate and present cases in staffing and integrated rounds
- Perform other assigned duties
- Comply with all policies and standards
Requirements:
- Applicants must hold one of: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state licensure and/or compact state licensure
- Experience in behavioral health and/or substance abuse, utilization management, and clinical review ideal
- Technologically savvy
- Excellent communication and customer service skills
- Self-starter
- Graduate of an accredited school of nursing or bachelor's degree
- 2–4 years of related experience
- License to practice independently and/or state-required licensure
- Master's degree for behavioral health clinicians 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
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
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