Utilization Management Specialist - Behavioral Health

You could be the one who changes everything for our 26 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.Review psychotropic medication utilization/prepare cases for Behavioral Health Medical DirectorPerform prior authorization reviewsPerform inpatient concurrent reviewsAssist with discharge planningEnsure all members are receiving the right care, in the right place, at the right time through Utilization Review and Discharge Planning work. Work with hospital staff, community agencies, members and families to coordinate effective and clinically appropriate discharge plans. Promote quality and cost effectiveness of healthcare by the appropriate application of policies and guidelines to prior authorization and concurrent review requests. Perform reviews of psychotropic medication utilization to insure appropriate and clinically indicated uses of psychotropic medications.Education and Experience:Master''s degree in Behavioral Health (LICSW, LMFT, LMHC, LPC, PHD, PsyD) or graduate from an accredited school of Nursing. Minimum of 3 years of experience in Mental Health or Substance Use Disorder treatment required.For Fidelis Care only: NYS LMFT, LCSW, LMSW, LMHC, Licensed Psychologist, or RN license required.Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.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.

Created: 2025-10-04