Behavioral Health Care Review Nurse in Clearfield, UT

Job Description We are excited to announce an opportunity for a dedicated Registered Nurse (RN) to join our team as a Behavioral Health Care Review Nurse. Ideal candidates will hold a current, active RN license and have experience specifically in the behavioral health sector. In this role, you will be responsible for providing prior authorization for outpatient and inpatient services for our behavioral health Medicaid population. Your expertise in post-acute care settings, such as nursing facilities, acute inpatient care, rehabilitation, long-term acute care hospitals, and behavioral health facilities, will be invaluable. We seek individuals with strong analytical and critical thinking skills, as well as a capacity for effective multitasking in a fast-paced environment. Work Schedule: • Monday to Friday, 8:00 AM to 5:00 PM EST during training (30-60 days) • Permanent schedule will require 4 to 5 working days per week, including at least one weekend day (Saturday or Sunday) • This is a remote position; a high-speed internet connection at home is required. Job Summary: You will support the clinical member services review assessment processes. Your primary responsibility will be to verify that services are medically necessary and conform to established clinical guidelines, insurance policies, and regulations. Through your work, you will help ensure that our members achieve desired health outcomes through coordinated care across the continuum. Essential Job Duties: • Assess member services to ensure maximum outcomes, cost-effectiveness, and compliance with state/federal regulations. • Analyze clinical service requests from members or providers against evidence-based clinical guidelines. • Identify appropriate benefits, eligibility, and expected length of stay for requested treatments and procedures. • Conduct reviews to determine prior authorization and financial responsibility for Molina and its members. • Process requests within established timelines. • Refer cases to medical directors and present them efficiently. • Request additional information from members or providers as necessary. • Make appropriate referrals to other clinical programs. • Collaborate with multidisciplinary teams to enhance the Molina care model. • Adhere to utilization management policies and procedures. Required Qualifications: • Minimum of 2 years of experience in acute care, inpatient review, prior authorization, managed care, or a combination of education and experience. • Active and unrestricted Registered Nurse (RN) license. • Ability to prioritize and manage multiple deadlines effectively. • Strong organizational, problem-solving, and critical thinking skills. • Excellent written and verbal communication abilities. • Proficiency in Microsoft Office suite and relevant software. Preferred Qualifications: • Certification as a Professional in Healthcare Management (CPHM). • Recent experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you're interested in this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive compensation package along with comprehensive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $26.41 - $61.79 / Hourly (Actual compensation may vary based on geographic location, experience, education, and/or skill level.)