Clinical Review Specialist
3 weeks ago
Join Centene Corporation, a leading healthcare company, as a Clinical Review Specialist. In this role, you will play a critical part in ensuring the quality and appropriateness of mental health and substance abuse services for our 28 million members.
Key Responsibilities:- Evaluate member treatment plans for mental health and substance abuse to ensure medical appropriateness
- Perform prior authorization reviews to determine medical necessity in accordance with regulatory guidelines
- Conduct concurrent reviews of behavioral health inpatient services to assess member health and treatment needs
- Analyze member data to improve quality and utilization of services
- Provide education to providers, members, and their families on behavioral health utilization processes
- Collaborate with healthcare providers to discuss level of care and services
- Engage with medical directors and leadership to improve care quality and efficiency
- Present cases in staffing and integrated rounds
- Graduate of an accredited school of nursing or bachelor's degree
- 2-4 years of related experience
- License to practice independently and/or state-required licensure
- Master's degree for behavioral health clinicians
Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401K, and stock purchase plans. We value diversity and are an equal opportunity employer. Qualified applicants with arrest or conviction records will be considered in accordance with applicable law.
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Clinical Utilization Review Specialist
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Carlton, TX, United States Centene Corporation Full timeJob Title: Clinical Utilization Review SpecialistJoin Centene Corporation, a leading healthcare company, as a Clinical Utilization Review Specialist. In this role, you will play a critical part in ensuring the quality and appropriateness of care for our 28 million members.Job Summary:We are seeking a highly skilled Clinical Utilization Review Specialist to...
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Clinical Review Specialist
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RN Clinical Reviewer
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RN Clinical Reviewer
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Licensed Utilization Review Specialist
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LPN Utilization Review Specialist
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Analytical Data Review Specialist
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LPN Utilization Review Specialist
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Utilization Review Clinician
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Afton, TX, United States Centene Corporation Full timeYou 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. Position Purpose: Performs a clinical review and assesses care related to mental...
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LPN Utilization Review Specialist
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LPN Utilization Review Specialist
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Clinical Documentation Specialist RN
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