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Utilization Review Clinician – Behavioral Health
Centene CorporationBehavioral health utilization clinician reviewing mental health and substance abuse treatment for Centene’s healthcare members. Assessing medical appropriateness, authorizations, inpatient care, and discharge planning.
Posted 8/5/2026full-timeRemote • Oklahoma • 🇺🇸 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 clinical reviews and assessments related to mental health and substance abuse, with a strong focus on prior authorization and utilization review processes. Engages effectively with healthcare providers and leadership to enhance care quality and efficiency.
Highest-signal resume keywords
Clinical ReviewUtilization ReviewBehavioral Health AssessmentState Licensure (LCSW, LMHC, LPC, LMFT, LMHP, RN)Master’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
Mental Health Treatment AssessmentSubstance Abuse Treatment AssessmentPrior Authorization ReviewConcurrent ReviewData Analysis for Quality Improvement
Soft Skills
Provider EducationCommunication with Healthcare TeamsCase Presentation
Certifications & Qualifications
State Licensure
Industry Keywords
Behavioral HealthCare Quality ImprovementDischarge PlanningRegulatory GuidelinesOklahoma Residency
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 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 utilization
- Educate providers, members, and families about the behavioral health utilization process
- Discuss levels of care and services with behavioral health healthcare providers
- Engage medical directors and leadership to improve care quality and efficiency
- Formulate and present cases in staffing and integrated rounds
- Comply with policies and standards and perform other assigned duties
Requirements
What you’ll need- Must reside in Oklahoma
- Graduate of an accredited school of nursing or 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
- LCSW, LMHC, LPC, LMFT, LMHP, or RN state/compact licensure required
- Clinical knowledge and ability to review or assess mental health and substance abuse treatment plans preferred
- Knowledge of mental health and substance abuse utilization review processes preferred
- Experience working with providers and healthcare teams to review related care services preferred
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K
- 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