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 Referrals increase your chances of interviewing at LanceSoft, Inc. by 2x. Get notified about new Clinician jobs in United States. #J-18808-Ljbffr