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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 compliance with regulatory guidelines and effective collaboration with healthcare teams. Proficient in evaluating treatment plans and improving service utilization through data analysis and provider education.
Highest-signal resume keywords
Licensed Clinical Social Worker (LCSW)Behavioral Health Utilization ReviewClinical Knowledge in Mental HealthExperience with Inpatient Care ReviewsMaster’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
Clinical ReviewTreatment Plan AssessmentPrior Authorization ReviewConcurrent ReviewData AnalysisDischarge PlanningBehavioral Health Authorization ReviewCare Quality ImprovementUtilization ManagementRegulatory Compliance
Soft Skills
CollaborationCommunicationEducationProblem-SolvingInterpersonal Skills
Certifications & Qualifications
Licensed Clinical Social Worker (LCSW)LMHCLPCLMFTLMHPRN State Licensure
Industry Keywords
Mental HealthSubstance AbuseBehavioral HealthInpatient CareResidential TreatmentPartial HospitalizationUtilization Review ProcessHealthcare TeamsCare ServicesRegulatory 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
- Review behavioral health authorizations for inpatient, residential treatment, and partial hospitalization settings
- Evaluate member treatment before, during, and after services
- Perform prior authorization reviews according to regulatory guidelines and criteria
- Conduct concurrent reviews of behavioral health inpatient care, including treatment needs and discharge planning
- Analyze behavioral health member data to improve quality and appropriate service utilization
- Educate providers, members, and families about the behavioral health utilization process
- Discuss levels of care and services with behavioral health providers
- Collaborate 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 and perform other assigned duties
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 (Licensed Clinical Social Worker) required, or LMHC, LPC, LMFT, LMHP, or RN state/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 applicants residing in the Central or Eastern United States time zones
- Monday–Friday availability, 8:00 a.m.–5:00 p.m. Eastern or Central time
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