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Utilization Review Clinician
1 week ago
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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