Utilization Review Clinician - Behavioral Health at Centene

**Who this is for** This role is for a licensed clinician with a background in behavioral health or substance abuse who is looking to apply their expertise in a

Work type: remote

Salary: $27 – $49/hr

Type: Full-time

Summary

**Who this is for** This role is for a licensed clinician with a background in behavioral health or substance abuse who is looking to apply their expertise in a utilization review capacity. You'll be instrumental in assessing the appropriateness of care for members with mental health and substance abuse needs. **Key highlights** This is a fully remote, full-time position where you will conduct clinical reviews for mental health and substance abuse services. You'll work within a call center environment, ensuring members receive medically appropriate levels of care and services. **You might be a good fit if you...** - Hold an active LPC, LCSW, LMFT, or RN license. - Have direct behavioral health/psychiatric experience. - Possess 2-4 years of related experience in behavioral health or substance abuse addiction disorders. - Are comfortable performing prior authorization and concurrent reviews.

Job Description

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.

Behavioral Health UR Clinical Call Center Environment - Coverage: 365/24 -7Applicants MUST be able to work Monday - Friday: 8 am – 5pm (CST) and have a LPC, LCSW, LMFT, or RN (Compact License) with direct behavioral health/psychiatric experience.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.

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 (BH) 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 regrading 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:

License to practice independently and have obtained the state required licensure as outlined by the applicable state is required

Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.

Requires Graduate of an Accredited Master’s degree - Behavioral Health related field is preferred

Master's degree AND 2 - 4 years of related behavioral health and/or substance abuse addiction disorders experience is required.

Direct experience with Utilization Review or Utilization Management related to Behavioral Health case is preferred

Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse is preferred.

Experience working with providers and healthcare teams to review care services, precertification, concurrent review, discharge reviews for mental health and substance abuse cases are preferred.

Direct IOP Behavioral Health and/or SUD inpatient hospital experience is preferred

Experience in Behavioral Health Case Management or Utilization Management in Managed Care Organizations, In-Patient Behavioral Health Units, Partial Hospitalization, or Residential Treatment is preferred

License/Certification:

LCSW - License Clinical Social Worker required or

LPC- Licensed Professional Counselor required or

LMFT - Licensed Marital and Family Therapist required or

RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Applicants MUST be able to work 8 am – 5pm (CST) and have a LPC, LCSW, LMFT, or RN (Compact License) with direct behavioral health/psychiatric experience

Pay Range: $27.02 - $48.55 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K 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.

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