Clinical Utilization Review Specialist

5 days ago


Columbia, Missouri, United States Centene Corporation Full time
Job Title: Clinical Utilization Review Specialist

Join Centene Corporation, a leading healthcare company, as a Clinical Utilization Review Specialist. In this role, you will play a critical part in ensuring our members receive the most appropriate care for their mental health and substance abuse needs.

Key Responsibilities:
  • Evaluate member treatment plans for mental health and substance abuse to ensure medical appropriateness
  • Perform prior authorization reviews for mental health and substance abuse services
  • Conduct concurrent reviews of behavioral health inpatient services to determine overall member health and treatment needs
  • Analyze member data to improve quality and utilization of behavioral health services
  • Provide education to providers, members, and their families on behavioral health utilization processes
  • Interact with behavioral health providers to discuss level of care and services
  • Collaborate with medical directors and leadership to improve care quality and efficiency
  • Formulate and present cases in staffing and integrated rounds
Requirements:
  • Graduate of an accredited school of nursing or bachelor's degree
  • 2-4 years of related experience
  • Independent licensure to practice as a clinical professional
  • Master's degree in behavioral health required
  • Clinical knowledge and ability to review and assess treatment plans for mental health and substance abuse
What We Offer:
  • Competitive pay
  • Comprehensive benefits package
  • Flexible work arrangements
  • Opportunities for professional growth and development


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