Insurance Utilization Review Clinician (New York)

Centene is hiring a Utilization Review Clinician. The candidate must reside and be licensed in New York.

Job responsibilities include:

• 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.

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.

Pay range is $26.50 - $47.59 per hour. For more information or to apply, please click here.