Clinician

• 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

Explore Utilization Review Clinician – Behavioral Health at Centene Corporation. Review requirements and application details.