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Utilization Review Clinician – Behavioral Health
Centene Corporation. Perform clinical reviews and assess care related to mental health and substance abuse .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical reviews and assessments related to mental health and substance abuse, with a strong focus on prior authorization processes and compliance with regulatory guidelines. Engages effectively with healthcare providers and multidisciplinary teams to enhance care quality and efficiency.
Highest-signal resume keywords
Licensed Clinical Social Worker (LCSW)Behavioral Health ExperienceUtilization Review ProcessClinical Knowledge in Mental HealthCollaboration with Healthcare Teams
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ReviewPrior Authorization ReviewBehavioral Health AssessmentTreatment Plan EvaluationData Analysis for Quality Improvement
Soft Skills
Provider EducationEffective CommunicationTeam Collaboration
Certifications & Qualifications
State LicensureMaster’s Degree in Behavioral Health
Industry Keywords
Mental HealthSubstance AbuseInpatient CareDischarge PlanningRegulatory Compliance
About the role
Key responsibilities & impact- Perform clinical reviews and assess care related to mental health and substance abuse
- Monitor and determine whether levels of care and services are medically appropriate
- Evaluate members’ treatment before, during, and after services
- Perform prior authorization reviews in accordance with regulatory guidelines and criteria
- Perform concurrent review of behavioral health inpatient care, including treatment needs and discharge planning
- Analyze behavioral health member data to improve quality and appropriate utilization
- Educate providers, members, and families regarding the behavioral health utilization process
- Discuss levels of care and services with behavioral health healthcare providers
- Engage medical directors and leadership to improve care quality and efficiency
- Formulate and present cases in staffing and integrated rounds
- Comply with all policies and standards
- Perform other duties as assigned
Requirements
What you’ll need- Graduate of an Accredited School of Nursing or Bachelor's degree and 2–4 years of related experience
- License to practice independently and/or state-required licensure
- Master’s degree for behavioral health clinicians required
- LCSW (Licensed Clinical Social Worker) required, or LMHC, LPC, LMFT, LMHP, or RN with state/compact state licensure
- 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
- 5+ years of behavioral health experience in a hospital-based, acute care, inpatient psychiatric, or behavioral health inpatient setting highly preferred
- Experience managing complex behavioral health populations and collaborating with multidisciplinary teams in a clinical environment ideal
Benefits
Comp & perks- 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
- Additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity