Job detail

Utilization Review Clinician - Behavioral Health

Centene Corporation

#Registered Nurse #Behavioral Health #Health Services #Mental Health #LMHC #LMFT #LPC #LCSW #Treatment Planning

Quick overview

Conducts clinical reviews and prior authorizations for mental health and substance abuse services to ensure medical appropriateness. Monitors inpatient stays and collaborates with providers and medical directors to optimize care quality and efficiency.

Requirements summary

Requires a Master's degree for behavioral health clinicians or a Bachelor's degree for nursing, along with 2-4 years of related experience. Must hold a valid professional license such as LCSW, LMHC, LPC, LMFT, LMHP, or RN.

bachelor degreepostgraduate degreeCase ManagementDischarge PlanningClinical AssessmentUtilization ReviewPrior AuthorizationTreatment Plan ReviewConcurrent ReviewBehavioral Health Analysis

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team.
Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Remote Role for licensed clinicians to conduct prior authorization and continued stay reviews for mental health services.
Clinicians who reside in Arkansas or have knowledge of Arkansas specific resources hihgly preferred.
Position Purpose: 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 regrading BH utilization process Interacts with BH healthcare providers as appropriate to discuss level of care and/or services Engages with medical directors and leadership to improve the quality and efficiency of care Formulates and presents cases in staffing and integrated rounds Performs other duties as assigned.
Complies with all policies and standards.
Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
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.
License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required Pay Range: $27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
Total compensation may also include additional forms of incentives.
Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Thanks for your interest in Centene and its subsidiary companies.
We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose.
Also, we’re here to help support you on your candidate journey.
Should you need an accommodation, please email recruiting@centene.com.
Centene is committed to helping people live healthier lives.
We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.

Utilization Review Clinician - Behavioral Health

Quick overview

Requirements summary

Job description

Benefits

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