Behavioral Health Clinician Advisor

5 days ago


Honolulu, Hawaii, United States Centene Corporation Full time
About the Job:

We are looking for a dedicated Behavioral Health Clinician Advisor to join our team.

Job Summary:

In this role, you will perform clinical reviews to assess mental health and substance abuse care, ensuring that services are medically appropriate and meet regulatory guidelines.

Responsibilities:
  • Evaluate members' treatment plans for mental health and substance abuse before, during, and after services to ensure they are medically necessary.
  • Conduct prior authorization reviews for mental health and substance abuse services to determine medical appropriateness in accordance with regulatory requirements.
  • Review behavioral health inpatient care to determine overall member health, treatment needs, and discharge planning.
  • Analyze behavioral health member data to improve quality and efficient utilization of services.
  • Provide education to providers, members, and their families regarding behavioral health utilization processes.
Requirements:
  • Graduate of an Accredited School of Nursing or Bachelor's degree with 2-4 years of related experience.
  • Licensure to practice independently and/or state-required licensure.
  • Masters degree required for behavioral health clinicians.
  • 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.
Benefits:

We offer a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements.



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