Centene

2 weeks ago

Inpatient Utilization Review Clinician, Behavioral Health

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 5 hours agoStatus: Live

Job Summary

Perform inpatient behavioral health utilization reviews by evaluating member treatment before, during, and after services to determine medical appropriateness. Conduct prior authorization reviews and concurrent inpatient reviews, analyze member data to improve quality, and support discharge planning. Educate providers, members, and families on the utilization process and collaborate with behavioral health providers, medical directors, and leadership through integrated rounds and case staffing.

Location: Louisiana

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Mid level

Key Responsibilities

•Evaluate members’ mental health and substance abuse treatment before, during, and after services to ensure medically appropriate level of care.
•Perform prior authorization reviews for mental health and substance abuse to determine medical appropriateness per regulatory guidelines and criteria.
•Conduct concurrent review of behavioral health inpatient cases to assess member health, treatment needs, and discharge planning.
•Analyze behavioral health member data to improve quality and appropriate utilization of services.
•Provide education to providers, members, and families on the behavioral health utilization process and coordinate with behavioral health providers, medical directors, and leadership.

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly

Perks:Health Insurance401kEquity

Key Requirements

•Graduate of an accredited nursing school or a Bachelor's degree, with 2–4 years of related experience.
•Master’s degree for behavioral health clinicians required.
•License to practice independently and/or state required licensure as outlined for the applicable state.
•2–4 years related experience with ability to review and assess treatment plans for mental health and substance abuse preferred.
•Must hold one of the listed licenses/certifications: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state/compact licensure.

Experience:2-4 yearsHealthcareBehavioral health

Education:Master's

Skills:Clinical assessmentData analysisCare coordinationCommunicationEducation

Licenses:LCSWLMHCLPCLMFTLMHPRN (Registered Nurse)

Company Brief

Centene

Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: St. Louis, United States

Founded: 1984

Website LinkedIn

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Centene

2 weeks ago

Inpatient Utilization Review Clinician, Behavioral Health

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 5 hours agoStatus: Live

Job Summary

Location: Louisiana

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Mid level

Key Responsibilities

•Evaluate members’ mental health and substance abuse treatment before, during, and after services to ensure medically appropriate level of care.
•Perform prior authorization reviews for mental health and substance abuse to determine medical appropriateness per regulatory guidelines and criteria.
•Conduct concurrent review of behavioral health inpatient cases to assess member health, treatment needs, and discharge planning.
•Analyze behavioral health member data to improve quality and appropriate utilization of services.
•Provide education to providers, members, and families on the behavioral health utilization process and coordinate with behavioral health providers, medical directors, and leadership.

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly

Perks:Health Insurance401kEquity

Key Requirements

•Graduate of an accredited nursing school or a Bachelor's degree, with 2–4 years of related experience.
•Master’s degree for behavioral health clinicians required.
•License to practice independently and/or state required licensure as outlined for the applicable state.
•2–4 years related experience with ability to review and assess treatment plans for mental health and substance abuse preferred.
•Must hold one of the listed licenses/certifications: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state/compact licensure.

Experience:2-4 yearsHealthcareBehavioral health

Education:Master's

Skills:Clinical assessmentData analysisCare coordinationCommunicationEducation

Licenses:LCSWLMHCLPCLMFTLMHPRN (Registered Nurse)

Company Brief

Centene

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: St. Louis, United States

Founded: 1984

Website LinkedIn