Utilization Review Clinician – Behavioral Health
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Job Description
Utilization Review Clinician reviewing mental health and substance abuse care for Centene members. Performing authorization, concurrent reviews, 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 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
- 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
- Comply with policies and standards and perform other assigned duties
Requirements:
- Graduate of an Accredited School Nursing or Bachelor's degree and 2–4 years of related experience
- License to practice independently and/or state-required licensure as applicable
- Master’s degree for behavioral health clinicians required
- LCSW (Licensed Clinical Social Worker) required, or LMHC, LPC, LMFT, LMHP, or RN state/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
- Candidates with 5+ years of behavioral health experience in hospital-based, acute care, inpatient psychiatric, or behavioral health inpatient settings highly preferred
- Experience managing complex behavioral health populations and collaborating with multidisciplinary teams in a clinical environment ideal
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
- Additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity
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