1 day ago

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: 8 hours agoStatus: Live

Job Summary

Perform medical necessity reviews and authorization determinations for mental health and substance abuse services supporting a Behavioral Health Medicare Plan. Evaluate treatment before, during, and after services, conduct prior and concurrent (inpatient) reviews, and analyze behavioral health member data to improve quality and utilization. Collaborate with behavioral health providers, medical directors, and leadership, and educate providers, members, and families on the utilization process.

Location: Florida

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Key Responsibilities

•Evaluate members’ treatment for mental health and substance abuse before, during, and after services to ensure medically appropriate level of care.
•Perform prior authorization reviews for mental health and substance abuse in line with regulatory guidelines and criteria.
•Conduct concurrent review of behavioral health inpatient to determine member health, treatment 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 interact with behavioral health providers as needed.

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly

Perks:Health Insurance401kEquityPaid Leave

Key Requirements

•Active RN license or independent clinical licensure (LCSW, LMHC, LMFT, LPC or LMHP) required.
•Master’s degree for behavioral health clinicians required.
•Graduate of an accredited school of nursing or a bachelor’s degree, with 2–4 years of related experience.
•Strong knowledge of medical necessity criteria and managed care principles.
•Behavioral health and/or utilization management experience preferred.

Experience:2-4 years

Education:Master's

Skills:Case reviewClinical assessmentPatient educationCollaboration

Licenses:LCSWLMHCLMFTLPCRN

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

1 day ago

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: 8 hours agoStatus: Live

Job Summary

Location: Florida

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Key Responsibilities

•Evaluate members’ treatment for mental health and substance abuse before, during, and after services to ensure medically appropriate level of care.
•Perform prior authorization reviews for mental health and substance abuse in line with regulatory guidelines and criteria.
•Conduct concurrent review of behavioral health inpatient to determine member health, treatment 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 interact with behavioral health providers as needed.

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly

Perks:Health Insurance401kEquityPaid Leave

Key Requirements

•Active RN license or independent clinical licensure (LCSW, LMHC, LMFT, LPC or LMHP) required.
•Master’s degree for behavioral health clinicians required.
•Graduate of an accredited school of nursing or a bachelor’s degree, with 2–4 years of related experience.
•Strong knowledge of medical necessity criteria and managed care principles.
•Behavioral health and/or utilization management experience preferred.

Experience:2-4 years

Education:Master's

Skills:Case reviewClinical assessmentPatient educationCollaboration

Licenses:LCSWLMHCLMFTLPCRN

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