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Utilization Review Clinician - Behavioral Health - Remote

Posted Yesterday
All others
Full Time
USA
$26.50 - $47.59/hour

Overview

This position offers the opportunity to make a significant impact on the lives of 28 million members by performing clinical reviews and assessments related to mental health and substance abuse.

In Short

  • Remote position with weekend and holiday rotation potential.
  • Work schedule is 8 AM - 5 PM PST.
  • Requires RN with compact license and behavioral health experience.
  • Conduct clinical reviews for mental health and substance abuse services.
  • Perform prior authorization reviews for medical appropriateness.
  • Analyze behavioral health member data for quality improvement.
  • Educate providers, members, and families about the utilization process.
  • Collaborate with healthcare providers and medical directors.
  • Present cases in staffing and integrated rounds.
  • Comply with all policies and standards.

Requirements

  • Graduate of an Accredited School of Nursing or Bachelor's degree.
  • 2-4 years of related experience required.
  • Master’s degree for behavioral health clinicians preferred.
  • Clinical knowledge of treatment plans related to mental health.
  • Experience with utilization review process preferred.
  • Working experience with healthcare teams is preferred.
  • Required licensure: LCSW, LMHC, LPC, LMFT, or RN.
  • State licensure as applicable.

Benefits

  • Competitive pay and comprehensive benefits package.
  • Health insurance and 401K options available.
  • Tuition reimbursement and paid time off.
  • Flexible work approach including remote, hybrid, and field options.
  • Equal opportunity employer committed to diversity.
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.

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