Utilization Review Clinician - Behavioral Health

Requirements

• Active RN license or independent clinical licensure (LCSW, LMHC, LMFT, LPC in Indiana)
• Behavioral health and/or utilization management experience preferred
• Strong knowledge of medical necessity criteria and managed care principles
• Schedule: Monday-Friday, 8:00 AM-5:00 PM
• Location: 100% Remote
• Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate.
• Evaluates member's treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate
• Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
• Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning
• Analyzes BH member data to improve quality and appropriate utilization of services
• Provides education to providers members and their families regrading BH utilization process
• Interacts with BH healthcare providers as appropriate to discuss level of care and/or services
• Engages with medical directors and leadership to improve the quality and efficiency of care
• Formulates and presents cases in staffing and integrated rounds
• Performs other duties as assigned.
• Complies with all policies and standards.
• Education/Experience: Requires Graduate of an Accredited School 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.
• License/Certification:
• 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
• Pay Range: $27.02 - $48.55 per hour
• Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Benefits

Additional Information

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Remote opportunity!! Join Centene as a Utilization Review Clinician - Behavioral Health! Centene is seeking a remote Utilization Review Clinician - Behavioral Health to support our Indiana Behavioral Health Medicaid Plan. In this role, you will perform medical necessity reviews and authorization determinations to ensure members receive appropriate, high-quality behavioral health services.

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