Remote Otter LogoRemoteOtter

Senior Utilization Review Clinician - Behavioral Health - Remote

Posted Yesterday
All others
Full Time
USA
$30.00 - $54.03/hour

Overview

The Senior Utilization Review Clinician plays a crucial role in assessing and ensuring the quality of mental health and substance abuse services for members, collaborating with healthcare providers, and identifying opportunities for process improvements.

In Short

  • Perform clinical reviews of mental health and substance abuse services.
  • Monitor and assess the appropriateness of care levels.
  • Handle complex clinical cases and workflows.
  • Conduct prior authorization reviews in accordance with guidelines.
  • Collaborate with healthcare providers on treatment plans.
  • Identify quality of care issues and potential fraud.
  • Engage with medical directors to enhance care quality.
  • Train new hires on workflows as a Subject Matter Expert.
  • Provide education regarding the behavioral health utilization process.
  • Comply with all policies and standards.

Requirements

  • Bachelor's degree required.
  • 4-6 years of related experience.
  • State required licensure (LCSW, LMHC, LPC, or LMHP).
  • Ability to assess complex treatment needs.
  • Experience with behavioral health services.
  • Strong communication skills.
  • Team collaboration abilities.
  • Knowledge of regulatory guidelines.
  • Critical thinking and problem-solving skills.
  • Commitment to quality care and member advocacy.

Benefits

  • Competitive pay.
  • Health insurance.
  • 401K and stock purchase plans.
  • Tuition reimbursement.
  • Paid time off plus holidays.
  • Flexible work schedules (remote, hybrid, field, or office).
  • Commitment to diversity and equal opportunity.
  • Support for candidate journey and accommodations.
  • Access to high-quality healthcare programs.
  • Innovative health solutions for families and individuals.
Centene Management Company logo

Centene Management Company

Centene Management Company LLC is a diversified national organization dedicated to transforming the health of communities by providing high-quality healthcare solutions to its 28 million members. With a focus on building strong partnerships between health plans and provider networks, Centene emphasizes optimal performance in care delivery, quality improvement, and cost utilization. The company values diversity and offers a comprehensive benefits package, including competitive pay, flexible work arrangements, and support for employee development. Centene is committed to helping individuals and families live healthier lives through innovative programs and a wide range of health solutions.

Share This Job!

Save This Job!

Similar Jobs:

M.S

Behavioral Health Utilization Management Clinician - Remote

Morgan Stephens

4 weeks ago

Join a leading healthcare organization as a remote Behavioral Health Utilization Management Clinician to ensure quality care for behavioral health services.

Worldwide
Contract
All others
$42/hour
United Community & Family Services logo

Behavioral Health Clinician - Remote

United Community & Family Services

13 weeks ago

UCFS is seeking a full-time Behavioral Health Clinician to provide intensive gambling treatment services and support individuals and families.

CT, USA
Full-time
Human Resources

T.C.O.P

Behavioral Health Clinician - Remote

The City of Providence

18 weeks ago

Join FSRI as a Behavioral Health Clinician to provide essential counseling and support services to individuals and families.

RI, USA
Full-time
All others
Octave logo

Behavioral Health Clinician - Remote

Octave

19 weeks ago

Join Octave as a Behavioral Health Clinician, providing high-quality therapy both in-person and remotely.

WA, USA
Contract
All others
$116 - $143/hour
Lorenzi Health logo

Behavioral Health Clinician (Bilingual) - Remote

Lorenzi Health

9 weeks ago

Join Lorenzi Health as a Behavioral Health Clinician and make a meaningful impact while enjoying flexible schedules and a supportive work environment.

MA, USA
Full-time
All others
63000 USD/year