Clinical Utilization Review Professional

5 days ago


Madison, Wisconsin, United States Centene Corporation Full time

We are seeking a highly skilled Clinical Utilization Review Professional to join our Medical Management/Health Services team at Centene Corporation. This is a remote position with a set schedule of Monday-Friday 8am-5pm during training, with some flexibility after.

Job Summary:

The successful candidate will be responsible for performing clinical reviews and assessing care related to mental health and substance abuse. They will determine if the level of care and services are medically appropriate and evaluate member's treatment for mental health and substance abuse before, during, and after services.

Key Responsibilities:

  • Evaluate member's treatment plans for mental health and substance abuse
  • Perform prior authorization reviews related to mental health and substance abuse
  • Conduct concurrent reviews of behavioral health inpatient treatment
  • Analyze behavioral health member data to improve quality and utilization of services
  • Provide education to providers, members, and families regarding behavioral health utilization
  • Interact with behavioral health providers to discuss level of care and services

Requirements:

  • Graduate of an Accredited School of Nursing or Bachelor's degree with 2-4 years of related experience
  • Licence to practice independently and/or state required licensure
  • Master's degree for behavioral health clinicians required
  • Clinical knowledge and ability to review treatment plans related to mental health and substance abuse preferred

Certifications:

  • LCSW, LMHC, LPC, LMFT, LMHP, or RN required

This is a remote position with a salary range of $110,000 - $140,000 per year, depending on qualifications and location. If you are a motivated and detail-oriented professional with a passion for improving healthcare outcomes, we encourage you to apply.



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