Care Review Clinician, Nurse Prior Authorization (California) Position Available In Calhoun, Alabama

Job Description:

• California residents preferred.
• California Nursing licensure required

•

JOB DESCRIPTION

Job Summary Molina Healthcare Services (HCS) works with members, providers andmultidisciplinary team members to assess, facilitate, plan andcoordinate an integrated delivery of care across the continuum,including behavioral health and long-term care, for members withhigh need potential. HCS staff work to ensure that patientsprogress toward desired outcomes with quality care that ismedically appropriate and cost-effective based on the severity ofillness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

Assesses services for members to ensure optimum outcomes, costeffectiveness and compliance with all state and federal regulationsand guidelines. Analyzes clinical service requests from members or providersagainst evidence based clinical guidelines. Identifies appropriate benefits and eligibility for requestedtreatments and/or procedures. Conducts prior authorization reviews to determine financialresponsibility for Molina Healthcare and its members. Processes requests within required timelines. Refers appropriate prior authorization requests to MedicalDirectors. Requests additional information from members or providers inconsistent and efficient manner. Makes appropriate referrals to other clinicalprograms. Collaborates with multidisciplinary teams to promote MolinaCare Model Adheres to UM policies and procedures. Occasional travel to other Molina offices or hospitals asrequested, may be required. This can vary based on the individualState Plan.

JOB QUALIFICATIONS

Required Education Any of the following: Completion of an accredited Registered Nurse (RN), LicensedVocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program ORa bachelor’s or master’s degree in a healthcare field, such associal work or clinical counselor (for Behavioral Health CareReview Clinicians only). Required Experience 1-3 years of hospital or medical clinic experience. Required License, Certification, Association Active, unrestricted State Registered Nursing (RN), LicensedVocational Nurse (LVN) or Licensed Practical Nurse (LPN) license ingood standing OR a clinical license in good standing, such as LCSW,LPCC or LMFT (for Behavioral Health Care Review Cliniciansonly). Must be able to travel within applicable state or locality withreliable transportation as required for internal meetings. Preferred Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth,Utilization Review / Utilization Management and knowledge ofInterqual / MCG guidelines.

• Preferred License, Certification, Association Active, unrestricted Utilization Management Certification(CPHM).

• WORK SCHEDULE

  Tues

• Sat shift will rotate with some holidays.
• Candidates who do not live in California must work

PACIFICDAYTIME HOURS

• To all current Molina employees: If you are interested in applyingfor this position, please apply through the intranet joblisting.

Molina Healthcare offers a competitive benefits and compensationpackage. Molina Healthcare is an Equal Opportunity Employer (EOE)

M/F/D/V Pay Range:

$25.1

• $48.94 / HOURLY
• Actual compensation may vary from posting based on geographiclocation, work experience, education and/or skill level.