Centene Corporation·Louisiana
Performs clinical reviews and assessments for mental health and substance abuse services to ensure medical appropriateness. Manages prior authorizations, concurrent reviews for inpatient care, and collaborates with providers and medical directors to improve care quality.
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.
This position is Tuesday-Saturday or Wednesday - Sunday 8am to 5pm with holiday rotation.
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.
Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.
$27.02 - $48.55 per hour
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
Requires a Bachelor's degree in Nursing or a Master's degree for behavioral health clinicians, plus 2-4 years of related experience. Must hold a valid professional license such as LCSW, LMHC, LPC, LMFT, LMHP, or RN.
Market context
Behavioral-health roles in Louisiana are often driven by ongoing demand for licensed clinicians who can support individuals with serious mental illness in community and outpatient settings. These positions can be competitive because employers typically look for active Louisiana licensure, at least two years of relevant experience, and a valid driver's license, while benefits such as dental, vision, paid holidays, sick leave, and an employee assistance program may help offset the workload. Before applying, confirm your licensure status and driver’s license are current, and note that the requirements and benefits here are AI-summarized from the original job description to save research time.
