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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 leadership to enhance care quality and efficiency.
Highest-signal resume keywords
Clinical ReviewPrior AuthorizationBehavioral Health Utilization ReviewLCSW 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 Treatment ReviewData AnalysisDischarge PlanningTreatment Plan Evaluation
Soft Skills
CommunicationCollaborationEducation
Certifications & Qualifications
LCSWLMHCLPCLMFTLMHPRN State License
Industry Keywords
Behavioral HealthUtilization ReviewHealthcare ProvidersRegulatory GuidelinesCare Quality
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 review of behavioral health inpatient care, including treatment needs and discharge planning
- Analyze behavioral health member data to improve quality and utilization
- Provide education to providers, members, and families regarding 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
- 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
- LCSW, LMHC, LPC, LMFT, LMHP, or RN state/compact 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 related care services 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