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

Molina Healthcare; City of Yonkers (NY); Remote; Full time

Job summary

Join a leading healthcare provider as a Care Review Clinician in New York. This remote role requires a licensed professional to assess and coordinate care for high-need members, ensuring compliance and optimal outcomes. Ideal candidates will have experience in behavioral health and managed care.

Qualifications

• At least 3 years of behavioral health hospital acute care or medical experience.

Responsibilities

• Assess inpatient services for optimal outcomes and compliance.
• Conduct inpatient reviews and prior authorization reviews.
• Collaborate with multidisciplinary teams.

Skills

Assessment

Analysis

Collaboration

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 our team as a Care Review Clinician, Inpatient Review (BH) LMHC, LCSW, LMSW Remote in New York at Molina Healthcare.

Job Summary

Molina Healthcare Services (HCS) collaborates with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate integrated care across the continuum, including behavioral health and long-term care, for members with high needs. Our staff ensure patients achieve desired outcomes through quality, medically appropriate, and cost-effective care tailored to illness severity and service site.

Job Description

We seek a candidate licensed as an LMHC, LCSW, or LMSW in New York, with experience in UM and inpatient review. The ideal candidate can work independently in a high-volume environment. Preference will be given to those with managed care organization (MCO), NYS Medicaid guidelines, and behavioral health experience. Details will be discussed during the interview.

This remote role requires NY licensure and offers a schedule of Monday to Friday, 8:30 am - 5:00 pm EST, with rotating weekends every 5-6 weeks and holidays.

Knowledge/Skills/Abilities

• Assess inpatient services to ensure optimal outcomes, cost-effectiveness, and compliance with all regulations.
• Analyze clinical service requests against evidence-based guidelines.
• Determine benefits, eligibility, and expected length of stay for treatments or 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 or providers as needed.
• Make referrals to other clinical programs.
• Collaborate with multidisciplinary teams to promote Molina Care Model.
• Adhere to UM policies and procedures.
• Occasional travel to Molina offices or hospitals may be required, depending on the State Plan.

Job Qualifications

Required Education

Master's Degree in Social Work, Psychology, or related Behavioral Health field.

Required Experience

At least 3 years of behavioral health hospital acute care or medical experience.

Required License and Certifications

• Active, unrestricted license in NY such as LCSW, LPCC, or LMFT.
• Valid driver’s license with a good record and reliable transportation.

State-Specific Requirements

For IL: Licensed in Illinois or applying within 30 days of employment; must hold a license such as LCSW, LPCC, LMFT, or RN.

Preferred Education

Master's in Clinical Social Work.

Preferred Experience

Recent behavioral health hospital experience in ICU, Medical, or ER units.

Preferred License

Unrestricted Licensed Clinical Social Worker.

Interested current Molina employees should apply via the intranet. Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Additional Details

• Pay Range: $26.41 - $51.49/hour

Job Details

• Level: Mid-Senior
• Type: Full-time
• Function: Healthcare Provider
• Industry: Hospitals and Healthcare