Behavioral Health Utilization Review Clinician

Molina Healthcare, Inc.; United States; On-site; USD 70,000 - 100,000; Full time

Job summary

Molina Healthcare, Inc. in the United States seeks a clinician to support member clinical service review processes in behavioral health.

The role ensures services are medically necessary and aligned with guidelines, policies, and regulations, contributing to high-quality, cost-effective member care across the care continuum. You will work with multidisciplinary teams to assess requests, determine prior authorizations, coordinate with medical directors, and monitor treatment plans.

Qualifications

• Health care experience, including behavioral health.
• Active, unrestricted licensure in state of practice.
• Knowledge of community resources.
• Ability to work independently with minimal supervision.
• Proactive, detail-oriented, and strong communication.
• Utilization management knowledge is a plus.

Responsibilities

• Assesses services for members ensuring outcomes, cost-effectiveness and regulatory compliance.
• Analyzes member or provider requests against evidence-based guidelines.
• Identifies benefits, eligibility and length of stay for treatments.
• Conducts prior authorization decisions and financial responsibility determinations.
• Processes requests within required timelines.
• Presents cases to medical directors and refers to appropriate programs.
• Requests information from members/providers as needed.
• Collaborates with multidisciplinary teams to support the Molina care model.
• Adheres to utilization management policies and procedures.
• Reviews BHT requests for medical necessity and best practices.
• Monitors treatment plans for effectiveness and progress.
• Coordinates with behavioral health directors to manage BHT benefits.

Skills

Communication skills

Time management

Critical thinking

Collaboration

Detail-oriented

Self-motivation

Multitasking

Proactive approach

Education

Active & unrestricted licensure (LCSW/LMSW/LPC/LPCC/LMFT or equivalent)

Tools

Microsoft Office

Job description

Molina Healthcare, Inc. in the United States seeks a clinician to support member clinical service review processes in behavioral health.

The role ensures services are medically necessary and aligned with guidelines, policies, and regulations, contributing to high-quality, cost-effective member care across the care continuum. You will work with multidisciplinary teams to assess requests, determine prior authorizations, coordinate with medical directors, and monitor treatment plans.