Utilization Review Clinician – Behavioral Health

Centene Corporation

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

Posted 10/22/2026full-timeRemote • New York • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core 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. Possesses the ability to collaborate effectively with healthcare providers and leadership to enhance care quality and efficiency.

Highest-signal resume keywords

Clinical LicenseBehavioral Health Utilization ReviewTreatment Plan AssessmentCollaboration With Healthcare ProvidersMaster's Degree in Behavioral Health

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical ReviewPrior Authorization ReviewConcurrent ReviewData AnalysisDischarge PlanningTreatment Needs EvaluationQuality ImprovementUtilization ManagementMental Health AssessmentSubstance Abuse Assessment

Soft Skills

Education and TrainingCommunicationCollaborationProblem-SolvingInterpersonal Skills

Certifications & Qualifications

LMSWLCSWLMHCLPCLMFTLMHPRN

Industry Keywords

Mental HealthSubstance AbuseBehavioral HealthUtilization ReviewHealthcare ComplianceCare QualityRegulatory GuidelinesTreatment PlansHealthcare TeamsClinical Knowledge

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 members’ treatment before, during, and after services
Perform prior authorization reviews according to 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 utilization
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
Comply with policies and standards
Perform other duties as assigned

Requirements

What you’ll need

Fully remote position requiring availability Monday through Friday from 8:30 a.m. to 5:00 p.m. Eastern Time
Active, applicable clinical license required; New York State licensure strongly preferred
Graduation from an accredited school of nursing or a 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
For Fidelis Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN 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

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