Care Review Clinician I (RN) - Behavioral Health: 100% Remote

Overview

Position Type: Full time

Job Title: Care Review Clinician I

Location: 100% Remote (Must reside in one of the following states: NV, AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI)

Offered Rate: $43.06/hr. On W2 (all inclusive)

Work Hours: Monday to Friday

Shifts: 5:00 AM–2:00 PM PST or 2:00 PM–11:00 PM PST

RN Licensing: RN must be licensed in Nevada or able to obtain Nevada licensure within 30 days of hire.

Location note: Remote (RN must be licensed in Nevada or eligible for Nevada licensure)

Responsibilities

• Conduct inpatient medical necessity and utilization reviews to ensure members receive the right care at the right time.
• Provide daily prior authorizations, concurrent reviews, and care assessments in accordance with policy and NCQA standards.
• Identify member benefits, eligibility, and appropriate length of stay for requested services or procedures.
• Collaborate with internal teams such as Behavioral Health and Long-Term Care to ensure continuity of care.
• Maintain departmental productivity and quality benchmarks.
• Mentor and support new team members as needed; consult with Medical Directors for complex or escalated cases.
• Build and maintain professional relationships with providers, members, and internal teams.
• Adhere to Molina’s policies, including compliance, confidentiality (HIPAA), and workplace standards.

Qualifications

• Strong understanding of Utilization Management and InterQual/MCG criteria.
• Familiarity with NCQA, HIPAA, and managed care regulations.
• Excellent communication, time management, and problem-solving skills.
• Proficient in Microsoft Office applications (Word, Excel, Outlook).
• Able to work independently and manage multiple priorities in a fast-paced environment.

Education & Experience

• Required: Completion of an accredited Registered Nursing (RN) program.
• Preferred: 0–2 years of clinical experience (hospital, utilization management, or case management).
• Experience in behavioral health or medical-surgical settings.

Licensure/Certification

• Active RN license (Nevada or able to obtain).
• ASAM certification (within 30 days of start date).

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• IT Services and IT Consulting

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