Utilization Review Clinician – Behavioral Health

Centene Corporation

. Perform clinical reviews and assess care related to mental health and substance abuse .

Posted 11/10/2026full-timeRemote • California • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical reviews and assessments related to mental health and substance abuse, with a strong focus on prior authorization and utilization review processes. Engages effectively with healthcare providers and leadership to enhance care quality and efficiency.

Highest-signal resume keywords

Clinical Review ExpertisePrior Authorization ReviewBehavioral Health Utilization ReviewLicensed Clinical Social Worker (LCSW)Master’s Degree in Behavioral Health

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentTreatment Plan ReviewData AnalysisDischarge PlanningUtilization Management

Soft Skills

Effective CommunicationProvider EducationTeam Collaboration

Certifications & Qualifications

LCSWLMHCLPCLMFTLMHPRN State Licensure

Industry Keywords

Mental HealthSubstance AbuseBehavioral HealthHealthcare ProvidersRegulatory Guidelines

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 member treatment before, during, and after services
Perform prior authorization reviews in accordance with regulatory guidelines and criteria
Perform concurrent reviews of behavioral health inpatient care, including treatment needs and discharge planning
Analyze behavioral health member data to improve quality and appropriate utilization of services
Educate providers, members, and families about the behavioral health utilization process
Discuss levels of care and services with behavioral health healthcare providers
Engage with 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 and perform other assigned duties

Requirements

What you’ll need

Graduate of an Accredited School 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
One of the following required licenses/certifications: LCSW, LMHC, LPC, LMFT, LMHP, or RN state and/or 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
Ability to work the training schedule Monday through Friday, 8–5 pm for the first few weeks
Ability to work an applicable main schedule, including rotating holidays and occasional overtime

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