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Utilization Review Clinician – Behavioral Health
Centene CorporationBehavioral health utilization review clinician assessing mental health and substance abuse care for Centene members. Performing authorizations, concurrent reviews, and discharge planning.
Posted 8/14/2026full-timeRemote • Texas • 🇺🇸 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 providers and healthcare teams to enhance care quality and efficiency.
Highest-signal resume keywords
Licensed RN, LCSW, LPC, LMHC, LMFT, LMHPOutpatient Behavioral Health ExperienceClinical Knowledge of Treatment PlansUtilization Review Process Knowledge2–4 Years of Related Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ReviewPrior Authorization ReviewConcurrent ReviewBehavioral Health Data AnalysisTreatment Planning
Soft Skills
Provider EducationInterpersonal CommunicationCollaboration with Healthcare Teams
Certifications & Qualifications
State Licensure in TexasLCSWLMHCLPCLMFTLMHP
Industry Keywords
Mental HealthSubstance AbuseBehavioral HealthUtilization ReviewDischarge Planning
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 in accordance with 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 appropriate utilization of services
- Educate providers, members, and families about the behavioral health utilization process
- Interact with behavioral health providers regarding level of care and services
- Engage with medical directors and leadership to improve care quality and efficiency
- Formulate and present cases in staffing and integrated rounds
- Comply with all policies and standards
- Perform other duties as assigned
Requirements
What you’ll need- RN, LCSW, LPC, LMHC, LMFT, or LMHP; must be licensed in Texas
- Outpatient behavioral health experience
- 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 required for behavioral health clinicians
- Required credential: LCSW, LMHC, LPC, LMFT, LMHP, or RN state/compact-state licensure
- Clinical knowledge of treatment plans related to mental health and substance abuse preferred
- Knowledge of the mental health and substance abuse utilization review process preferred
- Experience working with providers and healthcare teams to review related care services 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