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HomeCompaniesHckd Fa Us2 Oraclecloud Com CX 1Nurse Practitioner, Behavioral Health UM (PMHNP)- PST

Nurse Practitioner, Behavioral Health UM (PMHNP)- PST

Hckd Fa Us2 Oraclecloud Com CX 1 · United States; Remote Employees, Long Beach, CA, US · Remote · Active · Oracle Recruiting Cloud / Fusion HCM

Job facts

FieldValue
CompanyHckd Fa Us2 Oraclecloud Com CX 1
TitleNurse Practitioner, Behavioral Health UM (PMHNP)- PST
Normalized title-
Department / teamClinical
LocationUnited States
Work modelRemote / Remote
Employment typeFull Time
Salary-
Statusactive
ATS providerOracle Recruiting Cloud / Fusion HCM
Posted / first seen2026-06-19 / 2026-06-20
Changed / last seen2026-06-20 / 2026-06-20

Related slices

PageWhat it containsOpen
Company jobsActive postings from Hckd Fa Us2 Oraclecloud Com CX 1.Open
Company breakdownsRole, location, ATS, and work model facets for this company.Open
ATS provider jobsActive postings observed through Oracle Recruiting Cloud / Fusion HCM.Open
Provider filtered searchThe same provider as a filtered job collection.Open
Department jobsActive postings in Clinical.Open
Work model jobsActive Remote postings.Open
Lifecycle eventsOpen, update, close, and reopen events for this posting.Open
Original postingCanonical source or apply URL captured from the ATS.Open

Linked records

CompanyHckd Fa Us2 Oraclecloud Com CX 1
Source8214b818-efda-4f30-9713-cac0e888e0f9
ATS providerOracle Recruiting Cloud / Fusion HCM

Description

Description 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. 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., NCQA, URAC, CMS). Participates in UM 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, SAIs, and other cross-functional initiatives as assigned. Provides input to leadership regarding UM workflow optimization and emerging utilization trends. Job Qualifications REQUIRED QUALIFICATIONS: Master’s degree in Psychiatric-Mental Health Nursing from an accredited program. Completion of a Psychiatric-Mental Health Nurse Practitioner program at the master’s level with current national certification (PMHNP-BC) from the American Nurses Credentialing Center (ANCC). Minimum 3 years of experience as a Registered Nurse and/or Nurse Practitioner, ideally in managed care, behavioral health, or utilization management. Demonstrated experience in the application of medical necessity criteria and regulatory guidelines. Active, unrestricted state license to practice as a PMHNP, with the ability to obtain cross-state licensure (IL, AZ, CA, WA) as required. 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 or UM 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.

Full job record

Job ID9e4d1124877ee0f52122016e81a533cac2c844f3
Org ID6fcfe228-ec8c-4e31-bf8d-2e5d2cb49f0a
Source ID8214b818-efda-4f30-9713-cac0e888e0f9
Board ID8214b818-efda-4f30-9713-cac0e888e0f9
Provideroracle_hcm
Provider Job Key2037956
TitleNurse Practitioner, Behavioral Health UM (PMHNP)- PST
Normalized Title
Statusactive
Activeyes
Location TextUnited States; Remote Employees, Long Beach, CA, US
DepartmentClinical
Team
Employment Typefull_time
Workplace Typeremote
Remote Policyremote
CountryUnited States
Region
City
Salary RawDescription 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. 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., NCQA, URAC, CMS). Participates in UM 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, SAIs, and other cross-functional initiatives as assigned. Provides input to leadership regarding UM workflow optimization and emerging utilization trends. Job Qualifications REQUIRED QUALIFICATIONS: Master’s degree in Psychiatric-Mental Health Nursing from an accredited program. Completion of a Psychiatric-Mental Health Nurse Practitioner program at the master’s level with current national certification (PMHNP-BC) from the American Nurses Credentialing Center (ANCC). Minimum 3 years of experience as a Registered Nurse and/or Nurse Practitioner, ideally in managed care, behavioral health, or utilization management. Demonstrated experience in the application of medical necessity criteria and regulatory guidelines. Active, unrestricted state license to practice as a PMHNP, with the ability to obtain cross-state licensure (IL, AZ, CA, WA) as required. 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 or UM 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.
Salary Min
Salary Max
Salary Currency
Salary Period
Source URLhttps://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2037956
Apply URLhttps://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2037956
First Seen At2026-06-20 12:21:56Z
Last Seen At2026-06-20 12:21:56Z
Last Checked At2026-06-20 12:21:56Z
Last Changed At2026-06-20 12:21:56Z
Inactive At
Source Posted At2026-06-19 15:50:54Z
Source Updated At
Raw Payload Uris3://job-postings-prod-raw-590183727216/raw/provider=oracle_hcm/board=hckd.fa.us2.oraclecloud.com|CX_1/date=2026-06-20/2026-06-20T12-21-18-317Z-742654c58dff7c6e8ef44724500f7a8ada965bddf37a90f63ec6de55715bfc03.json
Event Fields
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Extensions
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