Join to apply for the Utilization Review Clinician - Behavioral Health role at Centene Corporation
1 day ago Be among the first 25 applicants
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.
Location & Schedule
Must reside in Oklahoma
Standard schedule Monday–Friday, 8:00 a.m.–5:00 p.m.
Occasional Saturday shifts and rotating holiday coverage required
Open to candidates holding a Compact Nursing License
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.
Responsibilities
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 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 regarding 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- Licensed Clinical Social Worker required
LMHC- Licensed Mental Health Counselor required
LPC- Licensed Professional Counselor required
Licensed Marital and Family Therapist (LMFT) required
Licensed Mental Health Professional (LMHP) required
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
For Fidelis Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required
Compensation
Pay Range $26.50 - $47.59 per hour
Benefits
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) 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.
Equal Opportunity Statement
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.
Seniority Level
Not Applicable
Employment Type
Full-time
Job Function
Health Care Provider
Industries
Hospitals and Health Care and Insurance