Clinical Review Clinician - Appeals - Behavioral Health

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.
 

• Requires Graduate from an Accredited School of Nursing or

• Master's degree in related Behavioral/Counseling field AND minimum of 2 – 4 years of related experience

• 6+ years of Behavioral Health experience managing Behavioral Health member caseloads, IOP Clinical Counseling/Social Work, or direct Psychiatric Nursing in Outpatient, ALF, SNF, Community Mental Health and/or Managed Care settings preferred.

• Direct work experience with clinical data, clinical review, and specifically the APPEALS process and procedures preferred.

• Knowledge of NCQA, Medicare and Medicaid regulations preferred.

• Knowledge of Utilization Management principles and processes preferred

• Role requires openness, adaptability, and flexibility to business changes, distribution of work, training, and technology processes

• Strong communication, attention to detail, organizational and time management skills

• Skilled at utilizing Microsoft Office applications (Co-Pilot, Excel, Outlook, Word, OneNote) and other digital communication tools (e.g. instant messaging, email, video conferencing, digital phone)

• Comfortable using video conferencing platforms (ZOOM Meeting, MS Teams)

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required or

• 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 Psychologist required

• For Health Net of California: RN license required

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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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