[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 # Nurse Practitioner, Behavioral Health UM (PMHNP) (WI) United States Healthcare & Clinical Listed on Molina Healthcare’s official careers site. Posted October 1, 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/2039546) [OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / Nurse Practitioner, Behavioral Health UM (PMHNP) (WI) ## Job description ### Job Summary Performs behavioral health utilization reviews, applying evidence-based criteria, and collaborating with physicians to ensure clinically appropriate, cost-effective, and regulatory-compliant care determinations. Assists in evaluating medical necessity, ensuring timeliness, and supporting the consistency of clinical decision-making across markets. Participates in a team-based, physician-led model that aligns with national clinical oversight standards and enterprise behavioral health initiatives. Contributes to overarching strategy to provide quality and cost-effective member care. ### Essential Job Duties - Performs behavioral health utilization management reviews for inpatient, outpatient, and intermediate level services using nationally recognized criteria (e.g., MCG, InterQual, ASAM). - Reviews medical documentation to determine the medical necessity, level of care, and continued stay appropriateness for behavioral health services. - Collaborates with behavioral health medical directors on complex or borderline cases - ensuring consistent application of criteria and alignment with regulatory standards. - Identifies quality of care, safety, and compliance concerns and escalate to the medical director as appropriate. - Maintains compliance with federal, state, and accreditation requirements (e.g., National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Centers for Medicare and Medicaid Services (CMS)). - Participates in utilization management quality audits, internal case reviews, and peer-to-peer education. - Supports process improvement initiatives and contributes to the development of clinical review guidelines and training materials. - Works under the medical direction and supervision of a licensed physician, consistent with state law and corporate policy. - Obtains and maintains multi-state licensure to support national coverage needs. - Participates in enterprise behavioral health workgroups, scoreable action items (SAIs), and other cross-functional initiatives as assigned. - Provides input to leadership regarding utilization management workflow optimization and emerging utilization trends. ### Required Qualifications - At least 5 years of experience as a registered nurse or nurse practitioner in managed care, behavioral health or utilization management, or equivalent combination of relevant education and experience. - Psychiatric-Mental Health Nurse Practitioner (PMHNP), and ability to obtain cross-state licensure as required. License must be active and unrestricted in state (WI) of practice. - Current national certification (PMHNP-BC) from the American Nurses Credentialing Center (ANCC). - Demonstrated experience in the application of medical necessity criteria and regulatory guidelines. - Strong customer service/member-centric focus. - Electronic Medical Record (EMR) proficiency. - Responsive in all forms of communication, and ability to remain calm in high-pressure situations. - Strong time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Problem-solving skills. - Ability to work within a variety of settings and adjust style as needed, including ability to work with diverse populations, various personalities and personal situations. - Ability to work independently, with minimal supervision and demonstrate self-motivation. - Ability to work cross-collaboratively within a highly matrixed organization. - Excellent verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. ### Preferred Qualifications - Prior experience in a managed care organization or payer-based utilization management setting. - Familiarity with Medicaid, Marketplace, and Medicare behavioral health regulations. - Strong working knowledge of clinical criteria (e.g., ASAM, MCG, InterQual). - Computer proficiency and experience with electronic medical record (EMR) or utilization management systems. ### 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 1, 2026 - First seen by OpenNash: Oct 11, 2026 - Last checked: Oct 18, 2026 - Listed for: 17 days - Location: United States[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039546) ## More jobs at Molina Healthcare ### [Associate Analyst, Provider Configuration](https://jobs.opennash.com/companies/molina-healthcare/jobs/8536d4cf5ecef9181415/) United States ### [Care Review Clinician, Applied Behavioral Analysis (ABA)](https://jobs.opennash.com/companies/molina-healthcare/jobs/db6392055f4082099f51/) United States ### [Care Review Processor](https://jobs.opennash.com/companies/molina-healthcare/jobs/4eab26e05fcac17c7310/) 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 ### [Telepsychiatry Behavioral Health Nurse Practitioner (PMHNP) - Remote in Missouri](https://jobs.opennash.com/companies/unitedhealth-group/jobs/a0d360eb37a73bb744c1/) UnitedHealth Group · St Louis, Missouri ### [Telepsychiatry Behavioral Health Nurse Practitioner (PMHNP) - Remote in Wisconsin or Iowa](https://jobs.opennash.com/companies/unitedhealth-group/jobs/2d68fa93f6633e5eb4a1/) UnitedHealth Group · Milwaukee, Wisconsin ### [In-Home Health - Nurse Practitioner or Physician Assistant (Part Time) -State College, PA](https://jobs.opennash.com/companies/cvs-health/jobs/bcfa71ecdbc0da5f0f5a/) CVS Health · Field-Pennsylvania ### [In-Home Health - Nurse Practitioner or Physician Assistant (Part Time) - Colorado Springs, CO](https://jobs.opennash.com/companies/cvs-health/jobs/b6abd723a6506d96c6b9/) CVS Health · Colorado Springs, CO OpenNash lists jobs from employers’ own careers sites and does not handle applications. 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