Care Review Clinician (BH Licensed)
M
Molina HealthcareBehavioral Health
Remote in FLFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- At least 2 years health care experience
- Required Skills
- Microsoft Office
Requirements
- Active and unrestricted behavioral health licensure in state of practice (LCSW, LMSW, LPC, LPCC, or LMFT).
- At least 2 years of health care experience in behavioral health or hospital acute care.
- Demonstrated knowledge of community resources.
- Ability to work independently and with minimal supervision.
- Proficiency in Microsoft Office suite and applicable software programs.
- Strong verbal and written communication skills.
- Excellent time-management, problem-solving, and critical-thinking skills.
- Experience with board certification or licensure as a behavioral analyst (BCBA or LBA) is a plus.
Responsibilities
- Assess services for members to ensure optimum outcomes, cost-effectiveness, and regulatory compliance.
- Analyze clinical service requests against evidence-based guidelines.
- Conduct reviews to determine prior authorization and financial responsibility.
- Process requests within required timelines and present cases to medical directors.
- Collaborate with multidisciplinary teams and behavioral health providers to support treatment planning.
- Monitor behavioral health treatment plans and evaluate efficacy for members with ASD and related disorders.
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