Utilization Review Clinician – Behavioral Health
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Job Description
Behavioral health utilization clinician reviewing mental health and substance abuse care for Centene. Assessing medical necessity, authorizations, inpatient treatment, and discharge planning remotely.
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 members’ 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 utilization
- Educate providers, members, and families regarding the behavioral health utilization process
- Discuss levels of care and services with behavioral health healthcare providers
- Engage with medical directors and leadership to improve care quality and efficiency
- Formulate and present cases in staffing and integrated rounds
- Comply with all policies and standards and perform other assigned duties
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
- LCSW (Licensed Clinical Social Worker) required, or LMHC (Licensed Mental Health Counselor) required, or LPC (Licensed Professional Counselor) required, or LMFT (Licensed Marital and Family Therapist) required, or LMHP (Licensed Mental Health Professional) required, or RN (Registered Nurse) state licensure and/or compact state licensure 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
- Ability to work Monday–Friday, 8am–5pm Central Time, with occasional weekends or holidays
- Applicants must be located in the Central Time Zone
Benefits:
- competitive pay
- health insurance
- 401K
- 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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