Clinical Utilization Review Specialist
2 weeks ago
Join Centene Corporation, a leading healthcare company, as a Utilization Review Clinician. 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 and experienced Utilization Review Clinician to join our Medical Management/Health Services team. As a Utilization Review Clinician, you will be responsible for performing clinical reviews and assessments of care related to mental health and substance abuse. Your expertise will help us determine the medical appropriateness of services and ensure that our members receive the best possible care.
Key Responsibilities:- Perform clinical reviews and assessments of care related to mental health and substance abuse
- Determine the medical appropriateness of services and ensure that our members receive the best possible care
- Evaluate member's treatment for mental health and substance abuse before, during, and after services
- Perform prior authorization reviews related to mental health and substance abuse
- Conduct concurrent reviews of behavioral health inpatient services
- Analyze behavioral health member data to improve quality and appropriate utilization of services
- Provide education to providers, members, and their families regarding behavioral health utilization process
- Interact with behavioral health healthcare providers 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
- Graduate of an accredited school of nursing or bachelor's degree and 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
- LCSW - License Clinical Social Worker required or
- LMHC - Licensed Mental Health Counselor required or
- LPC - Licensed Professional Counselor required or
- Licensed Marital and Family Therapist (LMFT) required or
- Licensed Mental Health Professional (LMHP) required or
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
$46.68 per hour
Centene 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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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