Top 627 Health Net Jobs

Utilization Review Clinician - Behavioral Health
Centene —Georgia
- $27.02 - $48.55 an hour
- Weekends as needed
- Remote
- LMFT
- Nursing
- Addiction Medicine
- Paid holidays
- Health insurance
Inpatient Utilization Review Clinician, Behavioral Health
Centene —Louisiana
- $27.02 - $48.55 an hour
- Full-time
- Remote
- LMFT
- Nursing
- Addiction Medicine
- Paid holidays
- Health insurance
7d
Corporate Ethics & Compliance Investigator
Centene —New York, NY
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- Paid holidays
- Health insurance
SIU Investigator
Centene —New York, NY
- $56,200 - $101,000 a year
- Full-time
- Remote
- 5 years
- Fair chance
- Senior level
- Paid holidays
- Health insurance
Senior Compliance Investigator
Centene —New York, NY
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Centene —New York, NY
- $236,500 - $449,300 a year
- Full-time
- Remote
- Medicine
- 5 years
- Fair chance
- Paid holidays
- Health insurance
13d
Remote Medical Director, Appeals
Centene —Washington, DC
- $236,500 - $449,300 a year
- Weekends as needed
- Remote
- Medicine
- Fair chance
- Senior level
- Paid holidays
- Health insurance
SIU Investigator
Centene —California
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Analysis skills
- Fair chance
- Paid holidays
- Health insurance
Senior Director, Clinical Data Science
Centene —Washington, DC
- $185,700 - $352,500 a year
- Full-time
- Remote
- Computer Science
- Master's degree
- SQL
- Paid holidays
- Health insurance
SIU Investigator
Centene —Ohio
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- Associate's degree
- Paid holidays
- Health insurance
Psychologist Reviewer
Centene —California
- $87,700 - $157,800 a year
- Full-time
- Remote
- Addiction Medicine
- Mid-level
- Outpatient experience
- Paid holidays
- Health insurance
6d
Senior Adversarial Emulation - Red Team Operator
Centene —New York, NY
- $87,000 - $161,300 a year
- Full-time
- Remote
- Computer science
- Azure
- Computer Science
- Paid holidays
- Health insurance
Manager, Sales Investigations
Centene —New York, NY
- $87,700 - $157,800 a year
- Full-time
- Remote
- High school diploma or GED
- Fair chance
- 1 year
- Paid holidays
- Health insurance
Associate Actuary - Medicaid
Centene —Washington, DC
- $87,700 - $157,800 a year
- Full-time
- Remote
- Research
- Mid-level
- Analysis skills
- Paid holidays
- Health insurance
Vice President, Provider Engagement
Fidelis Care —Long Island City, NY
- $188,900 - $359,800 a year
- Full-time
- Master's degree
- Bachelor's degree
- Mentoring
- Paid holidays
- Health insurance
Associate Actuary
Centene —Washington, DC
- $87,700 - $157,800 a year
- Full-time
- Remote
- Research
- Mid-level
- SQL
- Paid holidays
- Health insurance
4d
Senior Actuarial Analyst
Centene —New York, NY
- $70,100 - $126,200 a year
- Full-time
- Remote
- Mid-level
- SQL
- Math
- Paid holidays
- Health insurance
5d
Plan President & CEO - Health Net of California
Centene —Woodland Hills, CA
- $390,000 - $740,000 a year
- Full-time
- 5 years
- Master's degree
- Bachelor's degree
- Paid holidays
- Health insurance
4d
Actuary
Centene —New York, NY
- $107,700 - $199,300 a year
- Full-time
- Remote
- Microsoft Excel
- 5 years
- SQL
- Paid holidays
- Health insurance
Supervisor, Behavioral Health Utilization Management
Centene —Louisiana
- $75,300 - $135,400 a year
- Full-time
- LMFT
- Nursing
- RN License
- Paid holidays
- Health insurance
7d

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Utilization Review Clinician - Behavioral Health

Centene -
Georgia

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Job Details

Full-time
$27.02 - $48.55 an hour

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Master's degree

Full Job Description

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.

Must be licensed in the state of Georgia.

Must be willing to work an occasional weekend shift.

Must reside in EST or CST time zone.

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: $27.02 - $48.55 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, 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

Apply Now

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