Care Review Clinician, Inpatient Review (BH) LMHC, LCSW, LMSW Remote in New York

Molina Healthcare; Buffalo (NY); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a Care Review Clinician to join their remote team in New York. This role involves collaborating with multidisciplinary teams to ensure high-quality, cost-effective care for members with behavioral health needs. The ideal candidate will possess a Master's Degree in Social Work or related fields and have a strong background in inpatient review within behavioral health settings. This position offers a dynamic work environment with the opportunity to make a significant impact on patient care and outcomes. If you are passionate about improving health services and have the necessary licensure, we encourage you to apply.

Qualifications

• 3+ years in behavioral health hospital acute care or medical settings.
• Active, unrestricted State license (LCSW, LPCC, LMFT) required.

Responsibilities

• Assess inpatient services for optimal outcomes and compliance.
• Conduct inpatient reviews and process requests within timelines.

Skills

Inpatient Review Experience

Utilization Management Skills

Behavioral Health Knowledge

Clinical Analysis

Education

Master's Degree in Social Work

Master's in Clinical Social Work

Job description

Care Review Clinician, Inpatient Review (BH) LMHC, LCSW, LMSW Remote in New York

Join Molina Healthcare as a Care Review Clinician, Inpatient Review (BH) LMHC, LCSW, LMSW remotely in New York.

Job Summary

Molina Healthcare Services (HCS) collaborates with members, providers, and multidisciplinary teams to assess, plan, and coordinate integrated care across behavioral health and long-term care for high-need members. Our goal is to ensure patients achieve desired outcomes with quality, medically appropriate, and cost-effective care based on illness severity and service site.

Job Description

We seek a candidate with NY licensure (LMHC, LCSW, LMSW), inpatient review experience, and UM skills. The ideal candidate can work independently in a high-volume environment. Experience with managed care organizations (MCO), NY Medicaid guidelines, and behavioral health is highly preferred. Details will be discussed during the interview process.

This is a remote position requiring NY licensure. Work hours are Monday - Friday, 8:30 am - 5:00 pm EST, with rotating weekend and holiday shifts.

Knowledge/Skills/Abilities

• Assess inpatient services to ensure optimal outcomes, cost-effectiveness, and compliance with regulations.
• Analyze clinical service requests against evidence-based guidelines.
• Determine benefits, eligibility, and expected length of stay for treatments/procedures.
• Conduct inpatient reviews to assess financial responsibility; perform prior authorization reviews as needed.
• Process requests within required timelines.
• Refer cases to Medical Directors and present them efficiently.
• Request additional information from members/providers as needed.
• Make referrals to other clinical programs.
• Collaborate with multidisciplinary teams to promote Molina Care Model.
• Follow UM policies and procedures.
• Occasional travel to Molina offices or hospitals may be required.

Job Qualifications

Required Education: Master's Degree in Social Work, Psychology, or Behavioral Health.

Required Experience: 3+ years in behavioral health hospital acute care or medical settings.

Required License/Certification: Active, unrestricted State license (LCSW, LPCC, LMFT). Valid driver’s license with good record and reliable transportation.

State Specific Requirements: For IL, licensure within the state or application within 30 days of employment. Degree in Social Work, Psychology, or Nursing. Active license in good standing.

Preferred Education: Master’s in Clinical Social Work.

Preferred Experience: Recent hospital experience in ICU, Medical, or ER units.

Preferred License: Unrestricted Licensed Clinical Social Worker.

Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.