Behavioral Health Care Review Nurse in Vineyard, UT

JOB DESCRIPTION We are looking for a dedicated Registered Nurse (RN) with an active license to join our team as a Behavioral Health Care Review Nurse. Your expertise will be instrumental in providing prior authorization for both outpatient and inpatient services within the Medicaid behavioral health population. This role requires strong experience in post-acute care settings, such as nursing facilities, acute inpatient, rehabilitation, long-term acute care hospitals, and behavioral health facilities. Given the fast-paced nature of this position, excellent multitasking skills and productivity are essential. An analytical thought process will significantly contribute to your success. Work Schedule: Monday to Friday, 8:00 AM to 5:00 PM EST during the training period (30 to 60 days). Following training, the permanent schedule will require 4 to 5 days a week, including one weekend day (Saturday or Sunday). This is a remote position, and applicants must have high-speed internet connectivity at home. Job Summary: As the Behavioral Health Care Review Nurse, you will support clinical member services review assessment processes, ensuring services provided are medically necessary and compliant with established clinical guidelines, insurance policies, and regulations. You will assist members in achieving their desired health outcomes through an integrated care approach across the continuum. Essential Job Duties: • Assess services for members to guarantee optimal outcomes, cost-effectiveness, and adherence to state and federal regulations. • Analyze clinical service requests against evidence-based clinical guidelines. • Identify appropriate benefits, eligibility, and expected lengths of stay for requested treatments and procedures. • Conduct reviews to determine prior authorization and financial responsibility for Molina and its members. • Process requests within required timelines. • Refer cases to medical directors (MDs) efficiently and consistently. • Request additional information from members or providers as necessary. • Make appropriate referrals to other clinical programs. • Collaborate with multidisciplinary teams to promote the Molina care model. • Adhere to utilization management (UM) policies and procedures. Required Qualifications: • Minimum of 2 years of experience in hospital acute care, inpatient review, prior authorization, managed care, or a relevant combination of education and experience. • Active and unrestricted Registered Nurse (RN) license in your state of practice. • Strong ability to prioritize and manage concurrent deadlines. • Excellent organizational, problem-solving, and critical-thinking skills. • Outstanding written and verbal communication skills. • Proficiency in Microsoft Office Suite and relevant software programs. Preferred Qualifications: • Certified Professional in Healthcare Management (CPHM). • Recent experience in a hospital intensive care unit (ICU) or emergency room. To Current Molina Employees: If you are interested in applying for this opportunity, please do so through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package and is 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/or skill level.