Experienced Behavioral Health Utilization Review Clinician - Mental Health and Substance Abuse Services

Are you a compassionate and detail-oriented clinical professional with a passion for improving the lives of individuals struggling with mental health and substance abuse issues? Do you have a strong background in utilization review and a desire to work in a dynamic, patient-centered environment? If so, we encourage you to apply for the Utilization Review Clinician - Behavioral Health position at Centene, a leading healthcare company dedicated to delivering high-quality, affordable healthcare services to millions of members across the United States.

About Centene

As a diversified, national organization, Centene is committed to transforming healthcare by providing innovative, patient-centered solutions that improve health outcomes and reduce costs. With a strong focus on community-based care, we offer a range of services, including medical management, pharmacy benefits management, and behavioral health services. Our team of dedicated professionals is passionate about making a difference in the lives of our members and their families.

Job Summary

As a Utilization Review Clinician - Behavioral Health, you will play a critical role in ensuring that our members receive the most effective and efficient care possible for their mental health and substance abuse needs. You will conduct thorough clinical reviews of member treatment plans, assess the level of care and services provided, and make recommendations for improvement. Your expertise will help us identify areas for quality improvement and optimize the utilization of our behavioral health services.

Key Responsibilities

* Conduct thorough clinical reviews of member treatment plans to assess the level of care and services provided

• Evaluate member data to identify trends and areas for quality improvement
• Develop and implement strategies to optimize the utilization of behavioral health services
• Collaborate with healthcare providers, medical directors, and leadership to improve the quality and efficiency of care
• Present cases in staffing and integrated rounds to ensure that members receive the most effective and efficient care possible
• Perform other duties as assigned, including providing education to providers, members, and their families regarding behavioral health utilization processes

Essential Qualifications

* Graduate of an accredited school of nursing or bachelor's degree in a related field (e.g., social work, counseling, psychology)

• 2-4 years of related experience in utilization review, mental health, or substance abuse services
• Independent clinical licensure (e.g., LCSW, LMHC, LPC, LMFT, LMHP, RN)
• Master's degree in a related field (e.g., social work, counseling, psychology) preferred
• Clinical knowledge and ability to review and assess treatment plans related to mental health and substance abuse preferred
• Knowledge of mental health and substance abuse utilization review processes preferred
• Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred

Preferred Qualifications

* Experience working in a utilization review or case management setting

• Knowledge of regulatory guidelines and criteria related to mental health and substance abuse services
• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team

Skills and Competencies

* Strong clinical knowledge and expertise in mental health and substance abuse services

• Excellent analytical and problem-solving skills
• Strong communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong attention to detail and organizational skills
• Ability to prioritize tasks and manage multiple projects simultaneously
• Strong knowledge of regulatory guidelines and criteria related to mental health and substance abuse services

Career Growth Opportunities and Learning Benefits

At Centene, we are committed to helping our employees grow and develop their careers. We offer a range of training and development opportunities, including:

• On-the-job training and mentorship
• Professional development programs and workshops
• Leadership development programs
• Tuition reimbursement and education assistance
• Opportunities for advancement and career growth

Work Environment and Company Culture

Centene is a dynamic and patient-centered organization that values diversity, equity, and inclusion. We offer a range of benefits and perks, including:

• Flexible work arrangements, including remote and hybrid work options
• Competitive pay and benefits, including health insurance, 401(k), and stock purchase plans
• Paid time off and holidays
• Comprehensive training and development programs
• Opportunities for advancement and career growth

Compensation and Benefits

We offer a competitive salary range of $25.97 - $46.68 per hour, depending on experience and qualifications. Our comprehensive benefits package includes:

• Competitive pay and benefits, including health insurance, 401(k), and stock purchase plans
• Paid time off and holidays
• Comprehensive training and development programs
• Opportunities for advancement and career growth

Equal Opportunity Employer

Centene is an equal opportunity employer that is committed to diversity, equity, and inclusion. We value the ways in which we are different and believe that our diversity is a strength that enables us to provide high-quality, patient-centered care to our members. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

How to Apply

If you are a motivated and compassionate clinical professional with a passion for improving the lives of individuals struggling with mental health and substance abuse issues, we encourage you to apply for the Utilization Review Clinician - Behavioral Health position at Centene. Please visit our website to learn more about this opportunity and to apply online. Apply for this job