Behavioral Health Utilization Review RN

Molina Healthcare; United States; On-site; USD 33,000 - 71,000; Full time

Job summary

Molina Healthcare is seeking an RN with Behavioral Health experience to support member clinical service reviews and utilization management. You will verify medical necessity and ensure alignment with clinical guidelines, insurance policies, and regulations.

Responsibilities include assessing services, analyzing requests against guidelines, coordinating with medical directors, and promoting coordinated care across the Molina care model.

Qualifications

• At least 2 years health care experience, including behavioral health and/or hospital acute care.
• Licensure in behavioral health (LCSW, LMSW, LPC, LPCC, LMFT or equivalent) active in state of practice.
• May require BCBA/LBA or related behavioral analyst credentials.

Responsibilities

• Assess services for members ensuring outcomes and cost-effectiveness.
• Analyze clinical requests against evidence-based guidelines.
• Determine prior authorization/financial responsibility for Molina and members.

Skills

Healthcare experience

Behavioral health

Time management

Communication skills

Education

Behavioral health licensure

Tools

Microsoft Office

Job description

Molina Healthcare is seeking an RN with Behavioral Health experience to support member clinical service reviews and utilization management. You will verify medical necessity and ensure alignment with clinical guidelines, insurance policies, and regulations.

Responsibilities include assessing services, analyzing requests against guidelines, coordinating with medical directors, and promoting coordinated care across the Molina care model.