Job Overview
Location
Remote-IN
Job Type
Full-time
Category
Human Resources
Date Posted
June 23, 2026
Full Job Description
đź“‹ Description
- • Perform clinical reviews to assess medical necessity and appropriateness of behavioral health services for members enrolled in Indiana’s Medicaid plan, focusing on mental health and substance abuse treatment.
- • Conduct prior authorization reviews to determine if proposed behavioral health services meet regulatory guidelines and established medical necessity criteria.
- • Perform concurrent reviews of inpatient behavioral health stays to evaluate member health status, ongoing treatment needs, and discharge planning effectiveness.
- • Analyze behavioral health member data to identify trends, improve service quality, and promote appropriate utilization of care resources.
- • Communicate directly with behavioral health providers to discuss level of care, treatment plans, and authorization decisions.
- • Provide education to providers, members, and their families regarding the behavioral health utilization review process and coverage requirements.
- • Participate in staffing meetings and integrated rounds to present complex cases and collaborate on care coordination decisions.
- • Engage with medical directors and leadership teams to contribute to improvements in care quality, efficiency, and compliance with state and federal regulations.
- • Ensure all clinical reviews and determinations comply with company policies, state licensing standards, and managed care best practices.
- • Perform additional duties as assigned to support the operational goals of the Medical Management/Health Services team.
🎯 Requirements
- • Active RN license or independent clinical licensure (LCSW, LMHC, LMFT, LPC) in Indiana
- • Master’s degree for behavioral health clinicians
- • Strong knowledge of medical necessity criteria and managed care principles
🏖️ Benefits
- • Competitive pay ranging from $27.02 to $48.55 per hour
- • Comprehensive health insurance coverage
- • 401(k) and stock purchase plans
- • Tuition reimbursement
- • Paid time off and holidays
- • 100% remote work schedule with flexible work arrangements
Skills & Technologies
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About Centene Corporation
Centene Corporation is a publicly traded managed-care enterprise that arranges health-benefit programs for government-sponsored and privately insured individuals. Operating across all 50 U.S. states and internationally, the company focuses on under-insured and uninsured populations through Medicaid, Medicare, and Marketplace offerings. Its services include behavioral health, pharmacy benefits, vision, dental, telehealth, and in-house clinical programs. Centene partners with physicians, hospitals, and community organizations to coordinate cost-effective care, emphasizing data analytics and value-based reimbursement models. Headquartered in St. Louis, Missouri, it serves more than 25 million members, positioning itself as a leading intermediary between payers and healthcare providers.
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