Utilization Review Clinician – Behavioral Health
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Behavioral health utilization review clinician assessing mental health and substance abuse care for Centene members. Performing authorizations, concurrent reviews, and utilization improvement.
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 treatment needs and discharge planning
- Analyze behavioral health member data to improve quality and appropriate utilization of services
- Educate providers, members, and families about the behavioral health utilization process
- Discuss levels of care and services with behavioral health healthcare providers
- Collaborate with medical directors and leadership to improve care quality and efficiency
- Formulate and present cases in staffing and integrated rounds
- Perform other assigned duties and comply with policies and standards
Requirements:
- Graduate of an Accredited School 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
- One of the following required licenses/certifications: LCSW, LMHC, LPC, LMFT, LMHP, or RN state/compact state licensure
- 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 related care services 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
- Equal opportunity employer committed to diversity
Similar Jobs
Mental Health/Behavior Health Clinician – Contract
Part-time Colorado clinician providing virtual treatment for perinatal mood disorders. Supporting pregnant and postpartum patients through Delfina’s pregnancy care platform and clinical services.
Utilization Review Clinician – RN, PT, OT
Utilization Review Clinician reviewing post-acute care services and medical necessity for WellSky. Coordinating authorizations, transitions, and clinical reviews to improve healthcare outcomes.
Supervising Clinician, LPC-S
Supervising clinician providing LCSW-S/LPC-S oversight for associate therapists. Ensuring clinical quality, documentation accuracy, compliance, and provider development.
Supervising Clinician, LPC-S
Supervising Clinician overseeing associate therapists’ quality, documentation, and compliance. Remote supervision role for Impireum Psychiatric Group’s whole-person behavioral healthcare model.
Utilization Review Clinician – ABA
Utilization Review Clinician evaluating ABA care and prior authorizations for Centene healthcare members. Improving behavioral health service quality, utilization, and medical appropriateness.
Licensed Behavioral Health Clinician
Licensed clinician providing virtual short-term behavioral health therapy for Longwood University student-athletes. Conducting assessments, evidence-based interventions, risk screening, referrals, and care coordination.
Utilization Review Clinician – Behavioral Health
Utilization Review Clinician reviewing mental health and substance abuse care for Centene members. Performing authorization, concurrent reviews, and discharge planning remotely.
Licensed Behavioral Health Clinician, Addiction Medicine
Licensed clinician delivering remote addiction medicine care through Hawaii’s no-cost telehealth program. Providing psychotherapy, assessment, diagnosis, and treatment planning for substance use disorders.
Crisis Clinician
Remote Crisis Clinician providing televideo and phone-based behavioral-health crisis assessments, interventions, counseling, and referrals for HealthSource.
Crisis Line Clinician – Weekends
Crisis Line Clinician providing trauma-informed phone support through Compass Health Network’s Disaster Line. Assessing safety, connecting callers to resources, and coordinating care for Missouri communities.
Utilization Review Clinician – Behavioral Health
Behavioral health utilization clinician reviewing mental health and substance abuse care for Centene. Assessing medical necessity, authorizations, inpatient treatment, and discharge planning remotely.
Utilization Review Clinician – Behavioral Health
Behavioral health utilization review clinician assessing mental health and substance abuse care for Centene. Conducting authorizations, concurrent reviews, and provider education remotely in Florida.
Clinician Scheduler
Remote Clinician Scheduler managing complex clinician schedules across hospitals for USACS. Optimizing staffing, provider utilization, budgets, and shift coverage.
Utilization Review Clinician – Behavioral Health
Behavioral health utilization review clinician assessing mental health and substance abuse care for Centene members. Performing authorizations, concurrent reviews, and discharge planning.
Utilization Management Clinician
Utilization Management Clinician coordinating member care and authorizations for PacificSource, a health insurance provider. Reviewing medical necessity, discharge planning, provider resources, and cost-effective treatment across care settings.
Utilization Management Clinician
Utilization management clinician coordinating member care for PacificSource, a not-for-profit health insurer. Reviewing authorizations, inpatient stays, discharge plans, and cost-effective healthcare resources.
Clinician Coverage Scheduler
Clinician Coverage Coordinator scheduling OB hospitalist clinicians for OBHG, the nation’s largest OB hospitalist provider. Coordinating shifts, onboarding, coverage, and clinician relationships across hospital programs.
Consulting Clinician, MADRS Experience
Cogstate Clinicians remotely assess cognitive functions for clinical trials, working flexibly while contributing to global biopharmaceutical research.
Utilization Review Clinician – ABA
Utilization Review Clinician conducting prior authorization reviews for ABA treatment services. Evaluating clinical documentation for medical necessity with a focus on member care efficiency.
Utilization Management Clinician – Tuesday - Saturday
Utilization Management Clinician at PacificSource assessing member's health plan benefits and coordinating services. Working with healthcare professionals to promote quality, cost-effective healthcare outcomes.