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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 10/14/2026full-timeRemote • Missouri • 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. Collaborates 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 AnalysisDischarge PlanningTreatment Plan EvaluationQuality Improvement
Soft Skills
CollaborationEducationCommunication
Certifications & Qualifications
LCSWLMHCLPCLMFTLMHPRN State Licensure
Industry Keywords
Behavioral HealthMental HealthSubstance AbuseHealthcare 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
- Collaborate with medical directors and leadership to improve care quality and efficiency
- Formulate and present cases in staffing and integrated rounds
- Perform other assigned duties and comply with policies and standards
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/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 related care services preferred
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K plan
- 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