Utilization Review Clinician Behavioral Health

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical ManagementHealth Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Required Work Schedule: THURSDAY SUNDAY (Set Schedule)

NOTE: Position requires working EVERY SUNDAY and rotating holidays

Fulltime Flexible Hours: 4 days, 10 hours shifts (40 hrs per week)

Must be able to work Central Time Zone hours

NOTE: Must be fully licensed for the state of Texas via the Texas BHEC as an LPC, LCSW, or LMFT. Registered Nurse must have direct psychiatricmental health work experience and hold Texas State Licensure andor Compact State Licensure.

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 andor 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

• EducationExperience: Requires Graduate of an Accredited School Nursing or Bachelors degree and 2 – 4 years of related experience.
  

  • Requires Graduate of an Accredited School Nursing or Bachelors degree and 2 – 4 years of related behavioral health or substance abuse or ASAM experience. OR

  • Master’s degree for behavioral health clinicians is required

  • Masters degree AND 2 4 years of related behavioral health andor substance abuse addiction disorders experience is preferred.

  • Clinical knowledge and ability to review andor assess treatment plans related to mental health and substance abuse is preferred.

  • Knowledge of mental health and substance abuse utilization review process is preferred.

  • Experience working with providers and healthcare teams to review care services related to mental health and substance abuse is preferred.

  • Utilization Review Utilization management with behavioral health cases

  • Precertification, Concurrent Review, Discharge reviews for behavioral health

  • Direct in patient Behavioral Health and SUD inpatient hospital experience

  • Managed care knowledge is preferred

  • Working knowledge and experience with the ASAM Criteria and levels of care for Addiction Treatment is preferred

  • Direct BHSUD inpatient intake assessments experience is preferred

  • Direct work experience in InPatient Behavioral Health Units, Partial Hospitalization, or Residential Treatment is required

  • License to practice independently, andor have obtained the state required licensure as outlined by the applicable state required.

  • 
    LicenseCertification:

    • LCSW License Clinical Social Worker required or

    • LPC Licensed Professional Counselor required or

    • LMFT Licensed Marital and Family Therapist required or

    • RN Registered Nurse State Licensure andor Compact State Licensure required

    • Pay Range: $26.50 $47.59 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 individuals skills, experience, education, and other jobrelated factors permitted by law, including fulltime or parttime status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

      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