Utilization Review Clinician - Behavioral Health at Centene

**Who this is for** Licensed clinical professionals (RNs, LCSWs, LPCs, or LMFTs) authorized to practice in Texas who want to apply their clinical expertise to m

Work type: remote

Location: Remote-TX | Remote-NE | Remote-KS | Remote-WI | Remote-NM | Remote-MS | Remote-IA | Remote-AR | Remote-LA | Remote-MO | Remote-OK

Salary: $27 – $49/hr

Type: Full-time

Summary

**Who this is for** Licensed clinical professionals (RNs, LCSWs, LPCs, or LMFTs) authorized to practice in Texas who want to apply their clinical expertise to medical management and utilization review. **Key highlights** This role focuses on assessing the medical necessity of behavioral health and substance abuse treatments, ensuring members receive appropriate levels of care through prior authorization and concurrent reviews. **You might be a good fit if you...** - Hold an active, independent clinical license issued by the state of Texas. - Have 2-4 years of experience in behavioral health, substance abuse addiction, or managed care environments. - Possess strong knowledge of clinical review standards, including ASAM criteria. - Are available to work a set schedule within the Central Time Zone, including occasional holidays.

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 -7Required Work Schedule: Sunday – Thursday: 7 am - 4 pm, 8 am – 5 pm, or 9 am – 6 pm (CST) and some holidays may also be required.LPC, LCSW, LMFT, or RN Applicants may reside in other states, but must have their clinical license issued from the state of Texas.

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.

• 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.

• Clinical knowledge and ability to review and/or assess patients’ SPMI needs based on ASAM criteria is required

• Direct work experience with patients receiving care in IOP Behavioral Health settings, SUD Detox facilities, SUD Residential services, Partial Hospitalization services, or Managed Care organizations

• Experience with Utilization Review, Utilization Management related to Behavioral Health cases is preferred.

• LCSW - License Clinical Social Worker required for Texas

• LPC- Licensed Professional Counselor required for Texas

• LMFT - Licensed Marital and Family Therapist required for Texas

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required for Texas

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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