Clinical Utilization Specialist

1 day ago

Olympia, Washington, United States Centene Corporation Full time
Job Title: Clinical Utilization Specialist

Join Centene Corporation, a leading healthcare company, as a Clinical Utilization Specialist. In this role, you will play a critical part in ensuring our members receive the best possible care.

Job Summary:

We are seeking a highly skilled Clinical Utilization Specialist to join our Medical Management/Health Services team. As a Clinical Utilization Specialist, you will be responsible for performing clinical reviews and assessments of care related to mental health and substance abuse.

Key Responsibilities:
  • Perform clinical reviews and assessments of care related to mental health and substance abuse
  • Monitor and determine if level of care and services related to mental health and substance abuse are medically appropriate
  • Evaluate member's treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate
  • Perform prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
  • Perform concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning
  • Analyze BH member data to improve quality and appropriate utilization of services
  • Provide education to providers, members, and their families regarding BH utilization process
  • Interact with BH healthcare providers as appropriate to discuss level of care and/or services
  • Engage with medical directors and leadership to improve the quality and efficiency of care
  • Formulate and present cases in staffing and integrated rounds
  • Perform other duties as assigned
Requirements:
  • Graduate of an Accredited School of Nursing or Bachelor's degree
  • 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
What We Offer:

Centene Corporation 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.

  • Clinical Utilization Management Specialist

    2 weeks ago

    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 key member of our healthcare team, you will play a critical role in ensuring that our members receive the most appropriate and effective healthcare services.Key ResponsibilitiesUtilize clinical expertise to assess, plan, implement, coordinate, monitor,...

  • RN - Clinical Utilization Specialist

    1 month 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...

  • Clinical Utilization Review RN

    1 month 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...

  • Utilization Review Nurse

    3 weeks 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...

  • Utilization Management Nurse Specialist

    7 days ago

    Olympia, Washington, United States Cambia Health Solutions Full time

    Job Title: Utilization Management NurseCambia Health Solutions is seeking a skilled Utilization Management Nurse to join our Clinical Services team. As a Utilization Management Nurse, you will play a critical role in ensuring that our members receive the most appropriate and cost-effective healthcare services.Key Responsibilities:Conduct utilization...

  • Clinical Research Specialist

    4 weeks ago

    Olympia, Washington, United States Kaiser Permanente Full time

    Job SummaryWe are seeking a highly skilled and experienced Research Nurse Interventionist to join our team at Kaiser Permanente. As a key member of our research staff, you will play a critical role in the success of our clinical trials.Key ResponsibilitiesConduct clinical evaluations and interventions, utilizing professional clinical knowledge and education...

  • Clinical Nurse Specialist ICU

    2 weeks ago

    Olympia, Washington, United States Providence Full time

    Job SummaryWe are seeking a highly skilled Clinical Nurse Specialist to join our team at Providence St. Peter Hospital. As a Clinical Nurse Specialist, you will be responsible for providing expert clinical care to patients in the ICU, as well as serving as a resource to other staff and departments.Key ResponsibilitiesProvide expert clinical care to patients...

  • Clinical Nurse Specialist ICU

    2 weeks ago

    Olympia, Washington, United States Providence Full time

    Job SummaryThe Clinical Nurse Specialist (CNS) is a highly skilled clinician who serves as a resource to other staff and departments in the ICU. This expert clinician demonstrates expertise in education, mentoring, consulting, research, evidence-based practice, management, and systems improvement.Key ResponsibilitiesProvide expert consultation to all care...

  • Clinical Research Nurse

    3 weeks ago

    Olympia, Washington, United States Kaiser Permanente Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Research Nurse Interventionist to join our team at Kaiser Permanente. As a Research Nurse Interventionist, you will play a critical role in conducting clinical research studies, including reviewing EPIC schedules, screening and consenting participants, administering questionnaires, and...

  • Clinical Nurse Specialist

    3 weeks ago

    Olympia, Washington, United States MultiCare Health System, Inc. Full time

    Job SummaryWe are seeking a skilled and compassionate Registered Nurse to join our team at MultiCare Health System, Inc. As a Clinic Registered Nurse, you will play a vital role in delivering high-quality patient care and contributing to the success of our healthcare organization.Key ResponsibilitiesUtilize the nursing process to assess, plan, coordinate,...

  • Clinical Immunizing Pharmacist

    2 weeks ago

    Olympia, Washington, United States Rite Aid Full time

    Job SummaryThe Clinical Immunizing Pharmacist is responsible for assisting customers with their healthcare needs and maximizing health outcomes by filling prescriptions, providing clinical services, advising on therapies, and supervising pharmacy associates.Key ResponsibilitiesEnsure the accuracy and appropriateness of all prescriptions filled by completing...

  • Clinical Appeals Specialist

    2 weeks ago

    Olympia, Washington, United States Centene Corporation Full time

    Job Title: Clinical Appeals CoordinatorJoin Centene Corporation, a leading healthcare company, as a Clinical Appeals Coordinator and play a vital role in ensuring our members receive the best possible care.Job Summary:We are seeking a highly skilled and detail-oriented Clinical Appeals Coordinator to join our Medical Management/Health Services team. As a...

  • Clinical Nurse Specialist

    4 weeks ago

    Olympia, Washington, United States Amergis Full time

    Job SummaryAmergis is seeking a skilled Clinical Nurse Specialist to join our team. As a key member of our healthcare staff, you will be responsible for providing high-quality patient care in a variety of clinic environments in Tacoma or Federal Way.Key ResponsibilitiesEvaluate patient health status and identify areas for improvement to reduce health...

  • Clinical Care Specialist

    3 weeks ago

    Olympia, Washington, United States Optum Full time

    Optum HouseCalls Dual Statewide TravelerCompensation: $40,000 base salary, plus student loan repayment or sign-on bonus for eligible candidatesAbout the Role:As a Clinical Care Specialist with Optum HouseCalls, you will play a critical role in delivering high-quality, patient-centered care to individuals in the comfort of their own homes. Our team is...

  • Clinical Nurse Specialist

    2 weeks ago

    Olympia, Washington, United States Providence Service Full time

    About the RoleWe are seeking a skilled Clinical Nurse Specialist to join our team at Providence Medical Group Southwest Washington. As a leader in patient care, you will be responsible for assessing, planning, implementing, and evaluating all aspects of patient care and family teaching.Key Responsibilities:Lead the healthcare team in providing comprehensive...

  • Clinical Care Specialist

    2 weeks ago

    Olympia, Washington, United States Optum Full time

    Unlock a Rewarding Career with OptumAs a Clinical Care Specialist with Optum, you will have the opportunity to make a meaningful impact on the lives of patients across Washington and Oregon. Our HouseCalls program is revolutionizing the way we deliver healthcare, and we need dedicated professionals like you to join our team.About the RoleThis is a unique...

  • Clinical Nurse Specialist

    2 weeks ago

    Olympia, Washington, United States Providence Full time

    Job SummaryThe Clinical Nurse Specialist (CNS) is a highly skilled clinician who serves as a resource to other staff and departments, providing expert consultation and implementing improvements in healthcare delivery systems.Key ResponsibilitiesProvide expert consultation to all care providersImplement improvements in healthcare delivery systemsDevelop and...

  • Research Nurse Interventionist

    4 weeks ago

    Olympia, Washington, United States Kaiser Permanente Full time

    Job SummaryWe are seeking a highly skilled and experienced Research Nurse Interventionist to join our team at Kaiser Permanente. As a key member of our research staff, you will play a critical role in the success of our clinical trials.Key ResponsibilitiesConduct clinical evaluations and interventions, utilizing professional clinical knowledge and education...

  • Clinical Immunizing Pharmacist

    3 weeks ago

    Olympia, Washington, United States Rite Aid Full time

    Job SummaryThe primary purpose of this position is to assist customers with their healthcare needs and maximize health outcomes by filling prescriptions, providing clinical services, advising on therapies, providing excellent customer service, and supervising pharmacy associates. Frequent independent judgments are essential. The incumbent is also required to...

  • Clinical Research Nurse Specialist

    3 weeks ago

    Olympia, Washington, United States Recruitics JB Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Research Nurse Interventionist to join our team at Kaiser Permanente Washington clinics. As a key member of our research staff, you will play a crucial role in conducting a CDC research study to evaluate the effectiveness of the flu vaccine.The ideal candidate will have experience in recruiting...