Utilization Review Clinician

3 weeks ago


Olympia, United States Centene Corporation Full time

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.

**Must be licensed in either of the following states: TX, KS, WA, OK, LA**

**Behavioral experience required**

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

License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.

Masters degree for behavioral health clinicians required.

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

Knowledge of mental health and substance abuse utilization review process preferred.

Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.

**License/Certification:**

+ LCSW- License Clinical Social Worker required or

+ LMHC-Licensed Mental Health Counselor required or

+ LPC-Licensed Professional Counselor required or

+ Licensed Marital and Family Therapist (LMFT) required or

+ Licensed Mental Health Professional (LMHP) required or

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

Pay Range: $25.97 - $46.68 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. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act



  • Olympia, Washington, United States Centene Corporation Full time

    Job SummaryAs a Clinical Utilization Review Specialist at Centene Corporation, you will play a critical role in ensuring the quality and appropriateness of mental health and substance abuse services for our members. This position requires a strong clinical background and expertise in reviewing treatment plans related to mental health and substance abuse.Key...


  • Olympia, Washington, United States Providence St. Joseph Health Full time

    Job Summary:The Utilization Review (UR) Nurse plays a critical role in ensuring the efficient and effective management of patient care. As a Clinical Utilization Review Specialist, you will utilize your strong clinical background and knowledge of Utilization Management (UM) principles to develop and maintain processes for determining patient admission...


  • Olympia, Washington, United States CVS Health Full time

    Job SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a Utilization Management Nurse Consultant, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesReview services to ensure medical necessity and apply...


  • Olympia, Washington, United States CVS Health Full time

    Job SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a Utilization Management Nurse Consultant, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key Responsibilities:Review services to ensure medical necessity and apply...


  • Olympia, United States American Oncology Network, Inc. Full time

    Location:Vista OncologyPay Range:$20.48 - $34.12Position SummaryIn compliance with state requirements, maintains the ordering and stocking of medications and supplies as needed in the clinic. Under supervision of appropriate licensed healthcare professional as defined by State regulations, prepares and mixes medications. Coordinates with drug sales...


  • Olympia, Washington, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is seeking a travel nurse for a challenging opportunity in the Emergency Department. Job Details Specialty: ED - Emergency DepartmentDiscipline: RNDuration: 13 weeksHours: 36 hours per weekShift: 12 hours, nightsEmployment Type: TravelWellspring Nurse Source is committed to providing a supportive environment for our clinicians. We...

  • Medical Director

    4 weeks ago


    Olympia, Washington, United States TeamHealth Full time

    Join Our Team as a Medical Director in Post-Acute CareWe are seeking a highly skilled and experienced Medical Director to lead our post-acute care team in Olympia, Washington. As a Medical Director, you will be responsible for providing medical direction and oversight to our clinicians, ensuring high-quality patient care and outcomes.Responsibilities:Provide...


  • Olympia, United States Necnic Group Full time

    Medical Director Post Acute Care (FP, IM, Geriatrics) Seeking a BE/BC Family Medicine, Internal Medicine or Geriatrician to provide primary care to adults in skilled nursing facilities. Part-time position 2 to 3 days per week Schedule: Monday Friday. Flexible schedule. Set your own schedule and the opportunity to build a position that matches your ideal...


  • Olympia, Washington, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is seeking a skilled Cath Lab Technologist for a travel job in a medical setting.Job DetailsSpecialty: Cath Lab TechnologistDiscipline: Allied Health ProfessionalEmployment Type: TravelThe selected candidate will work 40 hours per week for 13 weeks, with a 10-hour shift schedule. This is a great opportunity for a Cath Lab Technologist...

  • Travel Nurse RN

    4 weeks ago


    Olympia, Washington, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is seeking a travel nurse for a Progressive Care Unit position.Job DetailsSpecialty: PCU - Progressive Care UnitDiscipline: RNDuration: 13 weeksHours: 36 hours per weekShift: 12 hours, nightsThe pay package is based on 12 hour shifts and 36.0 hours per week with a tax-free stipend amount to be determined.About Wellspring Nurse...


  • Olympia, Washington, United States ATI Physical Therapy Full time

    Job Title: Physical Therapy AideJoin ATI Physical Therapy, the largest outpatient orthopedic physical therapy company, as a Physical Therapy Aide. In this role, you will work alongside leading experts in the field of Physical and Occupational Therapy, providing direct patient care and support under the supervision of licensed clinicians.Key...


  • Olympia, United States TeamHealth Full time

    Do you have a passion for geriatric patients and enjoy solving complex medical problems within an interdisciplinary medical team? Do you enjoy working autonomously and thrive in a leadership role? TeamHealth has the perfect opportunity for you! This part-time medical director role will include patient care rounding and medical director duties in a...


  • Olympia, United States Assured Home Health & Hospice Full time

    We are hiring for a Patient Care Manager with Home Health experience for our Olympia, WA location! $95000 - $115000 / year At Assured Home Health a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serve—it...


  • Olympia, Washington, United States LHC Group Full time

    Job Description:We are seeking a skilled and compassionate Home Health Care Manager to join our team at LHC Group. As a key member of our home health care team, you will be responsible for the supervision and coordination of clinical services, providing and directing provisions of nursing care to patients in their homes as prescribed by the physician and in...


  • olympia, United States Assured Home Health & Hospice Full time

    We are hiring for a Patient Care Manager with Home Health experience for our Olympia, WA location!$95000 - $/ yearAt Assured Home Health a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serve—it truly is...


  • Olympia, United States Kaiser Permanente Full time

    PHLEBOTOMY EXPERIENCE A PLUS Job Summary: Would you like to fill an important role on a CDC research study to see how well the flu vaccine works? This position lasts about 4-6 months during flu season and enrolls patients being seen at Urgent Care with a respiratory illness. We are hiring for 5 Kaiser Permanente Washington clinics. This posting is for...


  • Olympia, Washington, United States American Greetings Full time

    Merchandising Role OverviewAmerican Greetings is a leading provider of celebratory products. As a Merchandiser with our company, you will play a vital role in helping people celebrate holidays, each other, and life's special moments. Your primary responsibilities will include merchandising and maintaining product displays within the greeting card department...

  • Travel Nurse RN

    3 weeks ago


    Olympia, Washington, United States Wellspring Nurse Source Full time

    Job Title: Emergency Department Travel Nursing PositionJob Description:We are seeking a skilled Emergency Department Registered Nurse for a travel nursing position in Olympia, Washington. As a travel nurse with Wellspring Nurse Source, you will have the opportunity to work in a dynamic and fast-paced environment while enjoying the benefits of travel...


  • Olympia, Washington, United States Montrose Environmental Full time

    About UsMontrose Environmental is a global environmental services provider offering a range of solutions to help clients optimize environmental resiliency.We strive to deliver value through our environmental planning and permitting, measurement and analytical services, and environmental resiliency and sustainability solutions.A key member of our team will be...

  • Senior Biologist

    3 weeks ago


    Olympia, Washington, United States Montrose Environmental Full time

    Job Summary We are seeking a highly qualified Senior Biologist to lead our environmental program for a utility company based in Southern California. This role will involve overseeing several vegetation management and wildfire mitigation programs on private and public lands. The ideal candidate will have experience in biological resource management and...