Jobs search

JOB DETAILS

Utilization Review Clinician - Behavioral Health

Centene • Full-time • Tampa, Florida, United States • $25.97 - $46.68 / hour • 1w ago

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate.

Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate
Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning
Analyzes BH member data to improve quality and appropriate utilization of services
Provides education to providers members and their families regrading BH utilization process
Interacts with BH healthcare providers as appropriate to discuss level of care and/or services
Engages with medical directors and leadership to improve the quality and efficiency of care
Formulates and presents cases in staffing and integrated rounds
Performs other duties as assigned
Complies with all policies and standards

Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.

License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.

Master’s degree for behavioral health clinicians required.

Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred.

Knowledge of mental health and substance abuse utilization review process preferred.

Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.

License/Certification:

LCSW- License Clinical Social Worker required or
LMHC-Licensed Mental Health Counselor required or
LPC-Licensed Professional Counselor required or
Licensed Marital and Family Therapist (LMFT) required or
Licensed Mental Health Professional (LMHP) required or
RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range: $25.97 - $46.68 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. 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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Related Jobs

Utilization Review Clinician - Behavioral Health

Centene • Full-time • Tampa, Florida, United States • $25.97 - $46.68 / hour • 1w ago

RN Utilization Review Psych

1w ago

VIEW JOB

Clinical Nurse Coordinator Behavioral Health

HCA Healthcare • Full-time • Tampa, FL, United States • 2m ago

RN Psych

Description Introduction Do you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients. At HCA Florida West Tampa Hospital our nurses set us apart from any oth... more

2m ago

VIEW JOB

Home Health Director of Clinical Training and Quality Review Nurse, Registered Nurse (RN)

Trilogy Home Healthcare Tampa Office • Full-time • Tampa, FL, US • 1m ago

RN Home Health Utilization Review

Home Health Director of Quality Assurance and Clinical Education, Registered Nurse (RN) Love Where You Work! Trilogy Home Healthcare is an exciting place to be right now! We are experiencing tremendous g... more

1m ago

VIEW JOB

Registered Nurse First Assistant (RNFA) (Days)

BayCare Health System • Full-time • Tampa, FL, US • 3w ago

RN OR

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thous... more

3w ago

VIEW JOB

PreOp/ PACU RN StaffFlex Contract $59.30/HR

AdventHealth • Full-time • Tampa, Florida, United States • 3w ago

RN PACU

Registered Nurse Contract StaffFlex All the benefits and perks you need for you and your family: Flexible contract assignments available Travel Nursing directly with AdventHealth, no 3rd party agency invol... more

3w ago

VIEW JOB

RN, Registered Nurse, Virtual-Days, Bilingual-Spanish

Banyan Medical Solutions • Full-time • Tampa, FL • $30 - $35 / hour • 4w ago

Registered Nurse (RN)-Telehealth/Virtual - Tampa Nursing Center Banyan Medical Systems – Tampa, FL 33614 Need a break from hospital life? We have several office based Virtual RN positions av... more

4w ago

VIEW JOB

Registered Nurse (RN)

Aspire at Oldsmar • Full-time • Oldsmar, FL, US • 1m ago

Aspire Health Group is looking for qualified Licensed RN's to join our family! Do you thrive in a family/team environment and desire to make a difference in the lives of others while advancing your skills? Are... more

1m ago

VIEW JOB

RN - Registered Nurse - Outpatient Diagnostic Cardiology - Part Time

BayCare Health System • Part-time • Safety Harbor, FL, US • 2w ago

RN Outpatient

2w ago

VIEW JOB

RN - Registered Nurse - PCU

BayCare Health System • Full-time • Riverview, FL, US • 3w ago

RN PCU

BayCare is looking for its newest Progressive Care, RN in Riverview, FL. The PCU Registered Nurse independently cares for a group of patients consistently using the nursing process and clinical standards., Modified, Modi... more

3w ago

VIEW JOB

Hospital Care Coordinator- RN Case Management

BayCare Health System • Full-time • Riverview, FL, US • 2m ago

2m ago

VIEW JOB