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Utilization Review Clinician - Behavioral Health

Centene • CA, US • published 2026-10-06 07:33:52.819626

Description

**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. **Key Details:** This fully remote role supports the California Market. Open to applicants in other states if they are able to the work the schedule: Monday through Friday, 9\-6 pm or 9:30am \- 6pm pacific time zone (depending on lunch) with rotating holidays and occasional over time. Preference will be given to applicants with behavioral health and utilization management or review experience. * 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 se...

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