Utilization Review Clinician - Behavioral Health

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Job Overview

Centene Corporation is seeking a Utilization Review Clinician to join their Medical Management/Health Services team. This role plays a vital part in overseeing care related to mental health and substance abuse for Centene’s 28 million members. The clinician will be responsible for performing clinical reviews, assessing the appropriateness of care, and ensuring that patients receive necessary treatment and support.

Key Responsibilities

The Utilization Review Clinician will undertake various tasks, including:

• Conducting clinical reviews to evaluate members’ treatment for mental health and substance abuse before, during, and after services to ensure medical appropriateness.
• Performing prior authorization reviews, assessing the level of care based on regulatory guidelines.
• Carrying out concurrent reviews of behavioral health inpatients to understand members' health and treatment needs for discharge planning.
• Analyzing member data to enhance the quality and appropriate use of services.
• Providing guidance to members, families, and providers on the behavioral health utilization process.
• Collaborating with healthcare providers and engaging medical directors to improve care quality and efficiency.
• Presenting cases during staffing and integrated rounds.
• Ensuring compliance with all company policies and standards.

Required Skills and Qualifications

Candidates for this position should possess a range of qualifications and skills, including:

• A Graduate degree from an accredited nursing school or a Bachelor's degree with 2-4 years of related experience.
• A Master’s degree is required for behavioral health clinicians.
• A license to practice independently, including state-specific licensure, is necessary.
• Clinical knowledge and experience in assessing treatment plans related to mental health and substance abuse is preferred.
• Familiarity with the utilization review process for mental health and substance abuse is highly advantageous.
• Experience working with healthcare teams for care service assessments related to mental health and substance abuse is beneficial.

Required licenses and certifications include:

• LCSW (Licensed Clinical Social Worker)
• LMHC (Licensed Mental Health Counselor)
• LPC (Licensed Professional Counselor)
• LMFT (Licensed Marital and Family Therapist)
• LMHP (Licensed Mental Health Professional)
• Registered Nurse (RN) licensure.

Salary and Benefits

The salary range for this position is $26.50 to $47.59 per hour. Centene offers a comprehensive benefits package, including:

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off and holidays
• Flexible work options, accommodating remote, hybrid, field, or office arrangements

The actual pay offered will depend on individual skills, experience, education, as well as full-time or part-time status. Additional incentives may also be included in total compensation.

Inclusivity and Equal Opportunity

Centene Corporation emphasizes inclusivity and diverse backgrounds in its workforce, committing to an environment that respects all differences among employees. The company ensures that all qualified applicants receive fair consideration, regardless of factors such as race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other legally protected characteristics.

Additionally, applicants with arrest or conviction records are also welcomed in accordance with the relevant legal frameworks.

This position is especially suited for candidates in the Eastern Time Zone.

Conclusion

For a job seeker interested in a fulfilling role within the healthcare sector, the Utilization Review Clinician position at Centene Corporation represents a unique opportunity, offering the chance to influence the care of millions while enjoying a flexible work-life balance through various working arrangements. The job's responsibilities are not only critical for the organization but also have a life-changing impact on the members it serves.

This job offer was originally published on himalayas.app