Utilization Review Clinician

1 week ago


Austin, Texas, United States Centene Corporation Full time

Join Our Team as a Clinical Professional at Centene
You have the opportunity to make a significant impact on the 28 million members we serve by joining our Medical Management/Health Services team. Centene, a national organization, values workplace flexibility and offers competitive benefits that give you a fresh perspective on your professional journey.

Job Description:

100% Remote Position - Must be licensed in the state of Texas

We are looking for candidates with the following qualifications:

  • Performs clinical review and assesses care related to mental health and substance abuse
  • Evaluates the treatment of members for mental health and substance abuse
  • Conducts prior authorization reviews for mental health and substance abuse services
  • Engages with healthcare providers to discuss care services
  • Provides education to providers, members, and families on behavioral health utilization processes

Key Responsibilities:

  • Monitors the appropriateness of level of care and services in mental health and substance abuse
  • Analyzes data to enhance service quality and utilization
  • Interacts with medical directors and leadership to enhance care efficiency
  • Formulates and presents cases in integrated rounds
  • Complies with all policies and standards

Education/Experience Requirements:

Graduate of an Accredited School of Nursing or Bachelor's degree with 2-4 years of related experience. Master's degree for behavioral health clinicians required.

License/Certification:

  • LCSW - License Clinical Social Worker required
  • LMHC - Licensed Mental Health Counselor required
  • LPC - Licensed Professional Counselor required
  • LMFT - Licensed Marital and Family Therapist required
  • LMHP - Licensed Mental Health Professional required
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Compensation:
Pay Range: $44.85 per hour [Actual pay adjusted based on skills, experience, education, and job-related factors permitted by law. Total compensation may include additional incentives.]

Centene Benefits Package:

  • Competitive pay
  • Health insurance
  • 401K and stock purchase plans
  • Tuition reimbursement
  • Paid time off plus holidays
  • Flexible work approach - remote, hybrid, field, or office schedules


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