Home › Companies › Hckd Fa Us2 Oraclecloud Com CX 1 › Nurse 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
| Field | Value |
|---|---|
| Company | Hckd Fa Us2 Oraclecloud Com CX 1 |
| Title | Nurse Practitioner, Behavioral Health UM (PMHNP)- PST |
| Normalized title | - |
| Department / team | Clinical |
| Location | United States |
| Work model | Remote / Remote |
| Employment type | Full Time |
| Salary | - |
| Status | active |
| ATS provider | Oracle Recruiting Cloud / Fusion HCM |
| Posted / first seen | 2026-06-19 / 2026-06-20 |
| Changed / last seen | 2026-06-20 / 2026-06-20 |
Related slices
| Page | What it contains | Open |
|---|---|---|
| Company jobs | Active postings from Hckd Fa Us2 Oraclecloud Com CX 1. | Open |
| Company breakdowns | Role, location, ATS, and work model facets for this company. | Open |
| ATS provider jobs | Active postings observed through Oracle Recruiting Cloud / Fusion HCM. | Open |
| Provider filtered search | The same provider as a filtered job collection. | Open |
| Department jobs | Active postings in Clinical. | Open |
| Work model jobs | Active Remote postings. | Open |
| Lifecycle events | Open, update, close, and reopen events for this posting. | Open |
| Original posting | Canonical source or apply URL captured from the ATS. | Open |
Linked records
| Company | Hckd Fa Us2 Oraclecloud Com CX 1 |
| Source | 8214b818-efda-4f30-9713-cac0e888e0f9 |
| ATS provider | Oracle 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 ID | 9e4d1124877ee0f52122016e81a533cac2c844f3 |
| Org ID | 6fcfe228-ec8c-4e31-bf8d-2e5d2cb49f0a |
| Source ID | 8214b818-efda-4f30-9713-cac0e888e0f9 |
| Board ID | 8214b818-efda-4f30-9713-cac0e888e0f9 |
| Provider | oracle_hcm |
| Provider Job Key | 2037956 |
| Title | Nurse Practitioner, Behavioral Health UM (PMHNP)- PST |
| Normalized Title | — |
| Status | active |
| Active | yes |
| Location Text | United States; Remote Employees, Long Beach, CA, US |
| Department | Clinical |
| Team | — |
| Employment Type | full_time |
| Workplace Type | remote |
| Remote Policy | remote |
| Country | United States |
| Region | — |
| City | — |
| Salary Raw | 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. |
| Salary Min | — |
| Salary Max | — |
| Salary Currency | — |
| Salary Period | — |
| Source URL | https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2037956 |
| Apply URL | https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2037956 |
| First Seen At | 2026-06-20 12:21:56Z |
| Last Seen At | 2026-06-20 12:21:56Z |
| Last Checked At | 2026-06-20 12:21:56Z |
| Last Changed At | 2026-06-20 12:21:56Z |
| Inactive At | — |
| Source Posted At | 2026-06-19 15:50:54Z |
| Source Updated At | — |
| Raw Payload Uri | s3://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 |
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