Utilization Management Specialist - Behavioral Health
Fidelis Care Getzville, New York
As a member of the Centene Medical Management/Health Services team, you’ll help innovate and execute strategies that redefine the industry standard for improving the lives and health of people. We’re a team of skilled physicians, nurses, pharmacists, social workers and health service experts who use our advanced clinical analytics to implement award winning programs, develop care, deliver partnerships, and work directly with our members to achieve outcomes that set us apart as industry leaders. Together, we’re transforming the health of communities, one person at a time.
What does it take?
What are the qualities that will help you achieve success in this role at Centene?
- Good listener
Our Medical Roles
Clinical & Nursing Opportunities at Centene
Our Clinical team is at the forefront of our purpose-driven work. Learn more about how you can help transform the health of our communities, one person at a time.
Overall Medical Management
A member of the Centene Medical Management team, we innovate and execute strategies that redefine the industry standard for improving the lives and health of people.
Concurrent Review Nurse
To ensure our members get the best quality of care, you’ll assess acute member health conditions, treatment and intervention options, and match them with providers, community and health plan resources.
Prior Authorization Nurse
You’ll ensure our members get the best quality services, assistive devices, and equipment to promote optimal health and independence in the community and help promote health and independence.
Working directly with members, interdisciplinary care team, providers and data analytics, you’ll identify member health risks and conditions and intervention and service options.
LTSS Program Specialist/Program Specialist Field Based
Working directly with our most vulnerable members, you’ll identify individual member health risks and opportunities to enhance independence, quality of life and community engagement.
You’ll use our data systems to directly assist providers, requesting services and treatments for our members.
To help support the individual needs of members and develop programs that address issues, you’ll review population health data, help design clinical programs, and develop care delivery partnerships.
Category Clinical & Nursing
Ensure 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.
Review psychotropic medication utilization/prepare cases for Behavioral Health Medical Director
Perform prior authorization reviews
Perform inpatient concurrent reviews
Assist with discharge planning
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.
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.
Check out this location
See what's near our Getzville location.View Map
“Centene is an exciting company to work for, the pace at which we’re growing allows numerous advancement opportunities. Also, we foster an environment that supports and offers numerous leadership growth opportunities.”- Esmeralda Baig, SVP Operations, Complex Care Products
“I assisted with one of the Provider fairs in the community. Seeing how much we care for our community and our patients was very eye opening.”- Julie Boulch, Director, Business Implementation Health Plan Initiatives
Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.Honored to be Honored
Our Hiring Process
Learn more about our hiring process and discover other helpful information for applicants.Learn More
“Flexibility is key. Centene is a company of change.”
Started as a Referral Specialist, now a Project Manager IVSee Ashley's career path
Match Your Skills
Let us search jobs for you based on the skills and experience listed in your LinkedIn Profile.Start Matching