Behavioral Health Utilization Review Clinician

As a Fortune 25 healthcare leader, we’re committed to providing high-quality, accessible care to individuals and families, especially in underserved communities. Our innovative approach integrates physical, behavioral and social services to make a real difference in health outcomes. We value collaboration and are dedicated to excellence, creating an environment where our employee contributions can truly shine. Join us in transforming healthcare and enhancing the well-being of communities across the country. To learn more about career opportunities with Centene, visit: https://jobs.centene.com/

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