Utilization Review Clinician – Behavioral Health

Centene Corporation

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

Posted 9/15/2026full-timeRemote • Kansas • 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 utilization management and quality improvement. Proficient in synthesizing clinical findings into actionable insights for healthcare providers and leadership.

Highest-signal resume keywords

Clinical Review ExpertiseUtilization ManagementBehavioral Health AssessmentLCSW/LMHC/LPC/LMFT LicenseData Analysis for Quality Improvement

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Record ReviewPrior Authorization ReviewConcurrent Review of Inpatient CareTreatment Plan AssessmentBehavioral Health Data Analysis

Soft Skills

Coaching ProvidersPresentation SkillsInterpersonal CommunicationCollaboration with Healthcare Teams

Certifications & Qualifications

Master’s Degree in Behavioral HealthState Licensure for Nursing or Behavioral Health

Industry Keywords

Mental HealthSubstance AbuseUtilization Review ProcessQuality ImprovementOutpatient Treatment Services

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
Support utilization management and quality improvement efforts
Identify outlier provider performance
Conduct comprehensive clinical record reviews
Deliver individualized coaching to providers
Synthesize findings into actionable presentations for providers and health plan leadership
Evaluate member treatment before, during, and after services
Perform prior authorization reviews according to 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
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 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, LMHC, LPC, LMFT, or LMHP license required, or RN state licensure and/or compact state licensure 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 providers and healthcare teams to review care services related to mental health and substance abuse preferred
Preference for experience in various mental health settings, especially outpatient and residential treatment services
Preference for utilization management/review experience
Preference for experience presenting to leadership/providers and advising providers on performance
Schedule availability Monday through Friday, 8–5 PM in Eastern, Central, Mountain, or Pacific time zone

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