Utilization Review Clinician - Behavioral Health

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. Key Details Must be available to work second shift. 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 regarding 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 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 LMHC-Licensed Mental Health Counselor required LPC-Licensed Professional Counselor required Licensed Marital and Family Therapist (LMFT) required Licensed Mental Health Professional (LMHP) required RN - Registered Nurse - State Licensure and/or Compact State Licensure required About Centene At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. Benefits Competitive pay Health insurance 401K and stock purchase plans Tuition reimbursement Paid time off plus holidays 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Equal Opportunity Employer 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. Additional Information Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email View email address on click.appcast.io. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well. #J-18808-Ljbffr