Behavioral Health Care Review Nurse in Nampa, ID

Job Description We are looking for a dedicated Registered Nurse (RN) to join our team as a Behavioral Health Care Review Nurse. This role involves providing prior authorization for both outpatient and inpatient services within the Kentucky Medicaid behavioral health population. The ideal candidate will have strong post-acute care experience, including in Nursing Facilities, Acute Inpatient, Rehabilitation, Long Term Acute Care Hospitals, or Behavioral Health Facilities. Excellent multitasking abilities and the capacity to thrive in a fast-paced environment are essential. Work Schedule: Monday through Friday, 8:00 AM to 5:00 PM EST - Training for 30 to 60 days. Permanent schedule will involve 4 to 5 days of work per week, including at least one weekend day (Saturday or Sunday). This is a remote position; candidates must have a home office with high-speed internet connectivity. The Behavioral Health Care Review Nurse will support the clinical member services assessment process, ensuring that all services align with established clinical guidelines, insurance policies, and regulations to facilitate optimal member outcomes through integrated care delivery. Essential Job Duties: • Assess member services to ensure optimal outcomes and compliance with state and federal regulations. • Analyze clinical service requests in accordance with evidence-based guidelines. • Determine appropriate benefits, eligibility, and projected length of stay for requested treatments. • Conduct reviews for authorization and financial responsibilities for Molina and its members. • Process requests within required timelines efficiently. • Refer cases to medical directors and present them consistently. • Request additional information from members or providers as necessary. • Channel 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, including roles in hospital acute care, inpatient review, prior authorization, or managed care. • Active and unrestricted Registered Nurse (RN) license. • Strong prioritization and time management skills. • Exceptional organizational and problem-solving abilities. • Excellent written and verbal communication skills. • Proficiency in Microsoft Office Suite and relevant software programs. Preferred Qualifications: • Certified Professional in Healthcare Management (CPHM). • Recent intensive care unit (ICU) or emergency room experience. Molina Healthcare is proud to offer a competitive benefits and compensation package. 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, work experience, education, and skill level.