Utilization Review Clinician

1 month 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 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

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.

Master’s 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.

  • RN - Utilization Review

    3 days ago

    Olympia, United States Providence Full time

    Description The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate...

  • RN - Utilization Review

    6 days ago

    OLYMPIA, United States Providence Full time

    Description The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate...

  • RN - Utilization Review

    22 hours ago

    Olympia, United States Providence Full time

    Description The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate...

  • Clinical Utilization Review RN

    5 days ago

    Olympia, Washington, United States Providence Full time

    About the RoleWe are seeking a skilled Utilization Review Nurse to join our team at Providence St. Peter Hospital. As a key member of our clinical team, you will play a critical role in ensuring that our patients receive the highest quality care while also optimizing our resources.Key ResponsibilitiesConduct comprehensive admission, concurrent, and...

  • RN - Utilization Review

    3 days ago

    Olympia, WA, United States Providence Full time

    Description The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission...

  • RN - Utilization Review

    7 days ago

    OLYMPIA, Washington, 98507, Thurston County, WA, United States Providence Full time

    Description The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission...

  • RN - Utilization Review

    24 hours ago

    Olympia, Washington, 98507, Thurston County, WA, United States Providence Full time

    Description The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission...

  • RN - Utilization Review

    7 days ago

    Olympia, WA, United States Providence Full time

    Description The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate...

  • RN - Utilization Review

    14 hours ago

    Olympia, WA, United States Providence Full time

    Description The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate...

  • RN - Clinical Utilization Specialist

    5 days ago

    Olympia, Washington, United States Providence Full time

    About the RoleWe are seeking a skilled Utilization Review Nurse to join our team at Providence St. Peter Hospital. As a key member of our clinical team, you will play a critical role in ensuring that our patients receive the highest quality care while also optimizing our resources.Key ResponsibilitiesConduct comprehensive admission, concurrent, and...

  • Advanced Practice Clinician, HouseCalls Dual Statewide Traveler

    5 days ago

    Olympia, Washington, United States Optum Full time

    About the RoleWe are seeking a highly skilled Advanced Practice Clinician to join our HouseCalls team as a Dual Statewide Traveler. As a key member of our team, you will be responsible for conducting in-home assessments and providing high-quality patient care to individuals across the state of Washington and Oregon.Key ResponsibilitiesConduct comprehensive...

  • Travel Nurse RN

    1 week ago

    Olympia, United States Cynet Health Full time

    Reviews the treatment plan with oncologist, is aware of expected outcomes and possible complications, and independently assesses the patient s general physical and emotional status.Implements plan of care for each patient (utilizing clinical pathways where applicable) and individualizes to meet the age specific needs of patients/significant others.Evidence...

  • Olympia Area Post-Acute Care Practice

    3 months ago

    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...

  • Advanced Practice Clinician, HouseCalls

    2 months ago

    East Olympia, United States Optum Full time

    $40,000 Student Loan Repayment Or $30,000 Sign-on Bonus For Individuals Who Have Not Previously Participated In This Program Flexible provider schedules available between 20-40 hours per week Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions...

  • Pharmacist - Clinical Consultant

    2 days ago

    Olympia, Washington, United States CVS Health Full time

    Job SummaryCVS Health is seeking a highly skilled Pharmacist - Clinical Advisor to join our team. As a Clinical Advisor, you will play a critical role in supporting our Employer segment and will be an integral part of the account team.Key ResponsibilitiesClinical Subject Matter Expertise: Serve as the clinical subject matter expert on the account team,...

  • Pharmacy Specialist Clinician

    2 weeks ago

    Olympia, WA, 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...

  • Traveling CT Imaging Specialist

    1 week ago

    Olympia, Washington, United States Edgemont Healthcare Staffing Full time

    Position Overview:Edgemont Healthcare Staffing is currently seeking a traveling CT Imaging Specialist to fill a vital role in the healthcare sector.Job Details:Specialty: CT Imaging SpecialistDiscipline: Allied Health ProfessionalEmployment Type: TravelWork Schedule: - 36 hours per week - 12-hour shifts, nights - Weekend Nights ONLY (Friday, Saturday,...

  • Chief Medical Officer

    2 weeks ago

    Olympia, Washington, United States CVS Health Full time

    Join CVS Health as a Chief Medical OfficerAt CVS Health, we are united by a singular mission: to bring our heart to every aspect of health care. This mission drives our dedication to providing enhanced, human-centered health care in a world that is constantly evolving.Our Heart At Work Behaviors™ embody this mission, empowering every employee to play a...

  • Hematology and Oncology Specialist

    2 weeks ago

    Olympia, Washington, United States Washington Permanente Medical Group Full time

    About Washington Permanente Medical GroupWashington Permanente Medical Group (WPMG) is a clinician-led, self-governed, and independent multi-specialty group practice dedicated to providing exceptional care to over 700,000 Kaiser Permanente patients throughout Washington state. Our approach is free from traditional healthcare barriers, emphasizing a...

  • Prosthetic and Orthotic Specialist

    1 week ago

    Olympia, Washington, United States Hanger, Inc. Full time

    About Us:At Hanger, Inc., we are dedicated to Empowering Human Potential. As the leading provider of orthotic and prosthetic (O&P) services and products globally, we offer cutting-edge O&P solutions, clinically distinct programs, and unparalleled customer service. Our Patient Care segment represents the largest network of O&P clinics across the nation....