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Utilization Review Clinician – Behavioral Health
Centene CorporationUtilization Review Clinician performing medical necessity reviews for behavioral health services to ensure members receive appropriate care. Remote role with Centene's Medical Management/Health Services team.
Posted 7/30/2026full-timeRemote • Florida • 🇺🇸 United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical necessity reviews and authorization determinations within behavioral health, ensuring appropriate utilization of services. Engages effectively with healthcare providers and leadership to enhance quality and compliance in mental health and substance abuse treatment.
Highest-signal resume keywords
Active RN LicenseIndependent Clinical LicensureBehavioral Health ExperienceUtilization Management ExperienceKnowledge of Medical Necessity Criteria
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Medical Necessity ReviewsAuthorization DeterminationsConcurrent ReviewBehavioral Health Data AnalysisTreatment Evaluation
Soft Skills
Provider EducationInterpersonal CommunicationEngagement with Leadership
Certifications & Qualifications
RN LicenseLCSWLMHCLMFTLPC
Industry Keywords
Mental HealthSubstance AbuseManaged Care PrinciplesUtilization ManagementBehavioral Health
About the role
Key responsibilities & impact- Perform medical necessity reviews and authorization determinations
- Monitor and determine if level of care and services related to mental health and substance abuse are medically appropriate
- Evaluate member’s treatment for mental health and substance abuse before, during, and after services
- Perform prior authorization reviews related to mental health and substance abuse to determine medical appropriateness
- Perform concurrent review of behavioral health (BH) inpatient
- Analyze BH member data to improve quality and appropriate utilization of services
- Provide education to providers, members, and their families regarding BH utilization process
- Interact with BH healthcare providers and engage with medical directors and leadership to improve quality
Requirements
What you’ll need- Active RN license or independent clinical licensure (LCSW, LMHC, LMFT, LPC)
- Behavioral health and/or utilization management experience preferred
- Strong knowledge of medical necessity criteria and managed care principles
- Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.
Benefits
Comp & perks- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules