Utilization Review Clinician - Behavioral Health

Centene
Texas
Workplace: RemoteFull timeUSD 27.02 - 48.55 hourlyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 2-4 yearsEducation: mastersSkills: ["Clinical review","Care assessment","Data analysis","Provider education","Cross-functional collaboration"]

Perform clinical utilization review for mental health and substance abuse care, ensuring medically appropriate levels of care before, during, and after services. Conduct prior authorization and concurrent reviews for behavioral health inpatient cases, analyze member data to improve utilization, and coordinate with BH providers, medical directors, and leadership. Educate providers and members/families on the utilization process and present cases in staffing and integrated rounds.

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FursaFursa
Centene
Centene
2 days ago

Utilization Review Clinician - Behavioral Health

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

Source: Company careers pageValidated by: Fursa AI
Last checked: 2 hours agoStatus: Live
Reposted: similar role first listed 6 months ago

Job Summary

Perform clinical utilization review for mental health and substance abuse care, ensuring medically appropriate levels of care before, during, and after services. Conduct prior authorization and concurrent reviews for behavioral health inpatient cases, analyze member data to improve utilization, and coordinate with BH providers, medical directors, and leadership. Educate providers and members/families on the utilization process and present cases in staffing and integrated rounds.
Location: Texas
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)

Key Responsibilities

  • •Perform clinical review assessing mental health and substance abuse care for medically appropriate levels of care.
  • •Evaluate treatment before, during, and after services to ensure appropriateness in line with regulatory guidelines.
  • •Conduct prior authorization reviews and concurrent inpatient reviews to determine needs and discharge planning.
  • •Analyze behavioral health member data to improve quality and appropriate utilization of services.
  • •Educate providers, members, and families on the behavioral health utilization process and coordinate with medical directors and leadership.

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly
Perks:Health Insurance401kPaid LeaveEquityRemote WorkPaid Holidays

Key Requirements

  • •Must hold an active Texas license to practice independently (RN in Texas, or LCSW/LMHC/LPC/LMFT/LMHP as applicable).
  • •Master’s degree for behavioral health clinicians is required.
  • •Graduate of an accredited school nursing program or a bachelor’s degree is required.
  • •2–4 years of related experience in behavioral health/utilization review is required.
  • •Clinical knowledge to review and assess mental health and substance abuse treatment plans is preferred.
Experience:2-4 yearsBehavioral healthMental healthSubstance abuseHealthcare providers
Education:Master's
Skills:Clinical reviewCare assessmentData analysisProvider educationCross-functional collaboration
Licenses:LCSWLMHCLPCLMFTLMHPRN

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
WebsiteLinkedIn