Utilization Review Clinician – Behavioral Health

Centene Corporation

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

Posted 9/23/2026full-timeRemote • Washington • 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, ensuring compliance with regulatory guidelines and improving care quality through collaboration with healthcare teams. Holds relevant licensure and advanced degrees necessary for independent practice and utilization review.

Highest-signal resume keywords

Active Washington RN LicenseLCSW, LMHC, LPC, LMFT, LMHP, or RN State LicensureClinical Review and AssessmentBehavioral Health Utilization Review ProcessCollaboration with Healthcare Teams

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewUtilization ReviewTreatment Plan AssessmentBehavioral Health Data AnalysisPrior Authorization ReviewConcurrent ReviewCare Quality ImprovementRegulatory Compliance

Soft Skills

Provider EducationCommunication with FamiliesCollaboration with Medical Directors

Certifications & Qualifications

Master’s Degree for Behavioral Health Clinicians

Industry Keywords

Mental HealthSubstance AbuseBehavioral HealthCare ServicesHealthcare Providers

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 according to regulatory guidelines and criteria
Perform concurrent reviews of behavioral health inpatient care
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
Collaborate with medical directors and leadership to improve care quality and efficiency
Formulate and present cases in staffing and integrated rounds
Comply with policies and standards
Perform other assigned duties

Requirements

What you’ll need

Graduate of an Accredited School Nursing or Bachelor's degree
2–4 years of related experience
Active Washington RN license or active Compact RN license required
License to practice independently and/or state-required licensure
Master’s degree for behavioral health clinicians required
One of the following required: 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 through Friday, 8:00 AM to 5:00 PM PST
Availability to participate in weekend and holiday rotation schedules

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
Equal opportunity employment
Consideration of qualified applicants with arrest or conviction records in accordance with applicable law