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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 medical necessity evaluations and prior authorization processes. Engages effectively with healthcare providers and leadership to enhance care quality and compliance with regulatory guidelines.
Highest-signal resume keywords
Clinical Review ExpertiseBehavioral Health Utilization ReviewMedical Necessity EvaluationLicensed Clinical Social Worker (LCSW)Master’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 ReviewTreatment Plan Evaluation
Soft Skills
Provider EducationInterpersonal CommunicationCollaboration with Healthcare Teams
Certifications & Qualifications
LCSWLMHCLPCLMFTLMHPRN State Licensure
Industry Keywords
Behavioral HealthMedicare PlanUtilization ManagementRegulatory ComplianceDischarge Planning
About the role
Key responsibilities & impact- Perform clinical reviews and assess care related to mental health and substance abuse
- Monitor and determine whether level of care and services are medically appropriate
- Perform medical necessity reviews and authorization determinations for inpatient and outpatient Behavioral Health Medicare Plan members
- Evaluate 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 member health, treatment needs, and discharge planning
- Analyze behavioral health member data to improve quality and appropriate utilization
- Educate providers, members, and families about the behavioral health utilization process
- Discuss level 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
- Perform other duties as assigned
- Comply with all 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 licensure 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
- Availability Monday–Friday, 8:00 AM–5:00 PM EST
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
- Equal opportunity employer committed to diversity