Behavioral Health Utilization Review Clinician

Molina Healthcare Inc; United States; On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a licensed behavioral health reviewer to support member clinical service review processes across the behavioral health continuum. You will verify medical necessity, ensure alignment with established clinical guidelines, insurance policies, and state/federal regulations, and promote outcomes through integrated care.

Collaborating with multidisciplinary teams, you will conduct prior authorization reviews, coordinate information requests, and support service delivery

Qualifications

• Licensed behavioral health professional required (LCSW/LMSW/LPC/LPCC/LMFT) with active state license.
• Strong knowledge of clinical guidelines, payer policies and regulatory requirements.
• Proven ability to operate independently and manage multiple tasks.
• Excellent written and verbal communication and relationship-building skills.

Responsibilities

• Assess member services for medical necessity and cost-effectiveness.
• Analyze clinical service requests against evidence-based guidelines.
• Determine benefits, eligibility and expected length of stay for treatments.
• Conduct prior authorization and financial responsibility reviews.
• Refer cases to medical directors and present cases efficiently.
• Collaborate with multidisciplinary teams to promote Molina care model.
• Adhere to utilization management policies and procedures.
• Potentially support ABA/BHT services for ASD and related disorders.
• Provide peer-to-peer consultation to in-network providers as needed.

Skills

LCSW/LMSW/LPC/LPCC/LMFT license

Regulatory knowledge

Communication skills

Time management

Problem solving

Detail oriented

Independent worker

Team collaboration

Microsoft Office

Education

Degree in social work or counseling (relevant)

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a licensed behavioral health reviewer to support member clinical service review processes across the behavioral health continuum. You will verify medical necessity, ensure alignment with established clinical guidelines, insurance policies, and state/federal regulations, and promote outcomes through integrated care.

Collaborating with multidisciplinary teams, you will conduct prior authorization reviews, coordinate information requests, and support service delivery