Behavioral Health Utilization Review Clinician

Molina Healthcare; United States; On-site; USD 70,000 - 95,000; Full time

Job summary

Molina Healthcare is seeking a Behavioral Health Utilization Review professional to support member clinical service review processes. You will verify medical necessity, align services with guidelines, policies, and regulations, and contribute to high-quality, cost-effective member care across the continuum.

The role involves analyzing requests, determining benefits and eligibility, and collaborating with medical directors and ABA/BHT teams to ensure appropriate utilization and treatment planning.

Qualifications

• Requires licensed behavioral health credential(s) (LCSW/LMSW/LPC/LPCC/LMFT) active and unrestricted in state of practice.
• Experience with behavioral health care settings and utilization management is preferred.
• Strong communication, organization, and collaboration skills are essential.

Responsibilities

• Assess services for members to ensure cost-effectiveness and regulatory compliance.
• Analyze clinical service requests against evidence-based guidelines.
• Determine benefits, eligibility and length of stay for treatments.
• Conduct prior authorization and financial responsibility reviews.
• Coordinate with medical directors and cross-disciplinary teams.

Skills

Behavioral health knowledge

Communication skills

Time management

Problem-solving

Microsoft Office proficiency

Education

LCSW / LMSW / LPC / LPCC / LMFT license

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a Behavioral Health Utilization Review professional to support member clinical service review processes. You will verify medical necessity, align services with guidelines, policies, and regulations, and contribute to high-quality, cost-effective member care across the continuum.

The role involves analyzing requests, determining benefits and eligibility, and collaborating with medical directors and ABA/BHT teams to ensure appropriate utilization and treatment planning.