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Utilization Review Clinician – Behavioral Health
Centene Corporation. Perform clinical reviews and assess care related to mental health and substance abuse .
Posted 9/16/2026full-timeRemote • California • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite
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 and utilization review processes. Engages effectively with healthcare providers and leadership to enhance care quality and efficiency.
Highest-signal resume keywords
Clinical ReviewUtilization ReviewBehavioral Health AssessmentLCSW LicenseMaster’s Degree in Behavioral Health
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Mental Health AssessmentSubstance Abuse ReviewPrior Authorization ReviewConcurrent ReviewData Analysis
Soft Skills
Provider EducationInterpersonal CommunicationCollaboration
Certifications & Qualifications
LCSWLMHCLPCLMFTLMHPRN State Licensure
Industry Keywords
Behavioral HealthCare QualityDischarge PlanningHealthcare 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 utilization of services
- Educate providers, members, and families about the behavioral health utilization process
- Interact with behavioral health healthcare providers regarding level of care and services
- 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
- Perform other duties as assigned
Requirements
What you’ll need- Graduate of an Accredited School Nursing or Bachelor's degree
- 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
Benefits
Comp & perks- 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
- Competitive pay
- Additional forms of incentives may be included in total compensation