Centene Corporation is a Fortune 500, mission-driven healthcare leader committed to transforming the health of the communities we service, one person at a time.
Inpatient Utilization Review Clinician, Behavioral Health
Location
California
Posted
5 days ago
Salary
$27 - $48 / hour
Seniority
Mid Level
Job Description
Inpatient Utilization Review Clinician, Behavioral Health
Centene Corporation
• 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 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.
Job Requirements
- 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
- 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
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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