[Skip to main content](#main-content) [OpenNash Jobs](https://jobs.opennash.com/) [Hiring report](/reports/hiring/) · [All Molina Healthcare jobs](https://jobs.opennash.com/companies/molina-healthcare/) · [Search jobs](/search/) Molina Healthcare · United States # RN Care Review Clinician - Behavioral Health United States Full-time Healthcare & Clinical Listed on Molina Healthcare’s official careers site. Posted October 20, 2026. Check that it is still open and apply there. [Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039913) [OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / RN Care Review Clinician - Behavioral Health ## Job description Seeking an RN with Behavioral Health, Psychiatric Nursing, Mental Health, Substance Use Disorder (SUD), Utilization Management, or Managed Care experience. ### Job Summary Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations, and ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. ### Essential Job Duties - Assesses services for members - ensuring optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. - Analyzes clinical service requests from members or providers against evidence based clinical guidelines. - Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. - Conducts reviews to determine prior authorization / financial responsibility for Molina and its members. - Processes requests within required timelines. - Refers appropriate cases to medical directors and presents cases in a consistent and efficient manner. - Requests additional information from members or providers as needed. - Makes appropriate referrals to other clinical programs. - Collaborates with multidisciplinary teams to promote Molina care model. - Adheres to utilization management (UM) policies and procedures. - May approve requests for BHT by reviewing behavioral assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not limited to: psychological evaluation requests, comprehensive diagnostic evaluations, functional behavioral assessments, and progress reports. - May perform ongoing monitoring of BHT treatment plans to evaluate effectiveness and treatment efficacy. - May collaborate and coordinate with behavioral health medical directors, and senior medical directors to ensure proper management of the BHT benefit. ### Required Qualifications - At least 2 years health care experience, including experience in behavioral health and/or hospital acute care, or equivalent combination of relevant education and experience. - Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT) or equivalent behavioral health licensure. License must be active and unrestricted in state of practice. - May require behavioral analyst experience, and/or board certification/licensure as a behavioral analyst (BCBA and/or LBA). - Demonstrated knowledge of community resources. - Ability to operate proactively and demonstrate detail-oriented work. - Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. - Ability to work independently, with minimal supervision and demonstrate self-motivation. - Responsive in all forms of communication, and ability to remain calm in high-pressure situations. - Ability to develop and maintain professional relationships. - Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Excellent problem-solving, and critical-thinking skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. ### To all current Molina employees If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V ## At a glance - Posted by the employer: Oct 20, 2026 - First seen by OpenNash: Oct 25, 2026 - Last checked: Oct 25, 2026 - Listed for: 5 days - Location: United States - Employment type: Full-time[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039913) ## More jobs at Molina Healthcare ### [Analyst, Pre-Pay Dispute Coding (Remote)](https://jobs.opennash.com/companies/molina-healthcare/jobs/c9837cbc4d806af2aff6/) United States ### [Associate Analyst, Provider Configuration](https://jobs.opennash.com/companies/molina-healthcare/jobs/8536d4cf5ecef9181415/) United States ### [Clinical Project Manager](https://jobs.opennash.com/companies/molina-healthcare/jobs/c6df61bf2408165cdb51/) United States ### [Clinical Validation Reviewer (DRG-RN)](https://jobs.opennash.com/companies/molina-healthcare/jobs/d8d2a9acba9d817b1255/) United States ### [Clinical Validation Reviewer (RN)](https://jobs.opennash.com/companies/molina-healthcare/jobs/0a542f06ec60c970567a/) United States ## Similar jobs at other companies ### [Senior Consultant - Behavioral Health](https://jobs.opennash.com/companies/oracle/jobs/2bbe062f7d7c2f04d376/) Oracle · United States ### [Licensed Behavioral Health Clinician - LCSW, LPC or LMFT](https://jobs.opennash.com/companies/unitedhealth-group/jobs/b0610c8d97ebcefd4dc2/) UnitedHealth Group · Bristol, Connecticut ### [Utilization Review Clinician - Behavioral Health](https://jobs.opennash.com/companies/centene/jobs/975a820f8a5c19033aa0/) Centene · Remote-NY ### [Registered Nurse Field Clinician - Richmond, VA - Senior Community Care](https://jobs.opennash.com/companies/unitedhealth-group/jobs/09739dff80d59d30e982/) UnitedHealth Group · Richmond, Virginia ### [Utilization & Review Clinician (MSW)](https://jobs.opennash.com/companies/universal-health-services/jobs/5af9905fde45830e371e/) Universal Health Services · SACRAMENTO, California OpenNash lists jobs from employers’ own careers sites and does not handle applications. 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