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2h ago Curated

Utilization Review Clinician (RN) - Behavioral Health

Molina Healthcare

Job description

Provides prior authorization for behavioral health services for the OH Medicaid population. Assesses medical necessity using clinical guidelines (ASAM, MCG). Schedule: Mon-Fri 8am-5pm EST with rotating weekends/holidays. After orientation, eligible for alternative work schedule. Requires active RN license (OH or compact), 2+ years experience in acute care, inpatient review, or managed care. Behavioral health experience preferred.

Key responsibilities

  • Assess services for members to ensure optimum outcomes, cost-effectiveness, and compliance
  • Analyze clinical service requests against evidence-based guidelines
  • Determine prior authorization and financial responsibility
  • Process requests within required timelines
  • Refer appropriate cases to medical directors
  • Request additional information from members or providers
  • Make appropriate referrals to other clinical programs
  • Collaborate with multidisciplinary teams

What you bring

  • Active RN license (OH or compact)
  • 2+ years experience in acute care, inpatient review, prior authorization, or managed care
  • Behavioral health experience preferred
  • Proficiency in Microsoft Office
  • Strong organizational, problem-solving, and critical-thinking skills

Tags

RemoteBehavioral HealthUtilization ReviewPrior AuthorizationMedicaid

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