Utilization Review Clinician (Texas-Remote)
Centene is hiring a Utilization Review Clinician in Texas. This is a remote position for a licensed individual.
Responsibilities:
• 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
Education/Experience:
• Requires a Master’s degree related to Mental Health, Counseling, or Social Work, or a graduate of an Accredited School Nursing and 2 – 4 years of related behavioral health/ psychiatric experience.
• License to practice independently and have obtained the state required licensure as outlined by the applicable state is 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 mental health providers and behavioral health healthcare teams.
For more information or to apply, click here.
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