Inpatient Review Clinician (RN) California Position Available In Calhoun, Alabama

Job Description:

• California residents preferred.

EMERGENCY ROOM ADMISSIONS REVIEW NURSE

• 3-12

DAY SHIFT:

• 7:30AM
• 08:30PM
• PACIFIC

HOURS NON

EXEMPT, 3days a week will rotate.

• TRAINING SCHEDULE WILL BE

• Monday thru Friday
• -8:30AM to 5:30PMPACIFIC throughout a 2
• 3 month training and then will move to a 3day/12 hour shift after training is completed. Training hours aremandatory.
• This position supports our California Health Plan. Candidates canlive anywhere in the USA
• if•they have a•valid•

CALIFORNIA

RNlicense and must work

• the Pacific Time Zone shift hours as posted

•

JOB DESCRIPTION

Job SummaryMolina Healthcare Services (HCS) works with members,providers and multidisciplinary team members to assess, facilitate,plan and coordinate an integrated delivery of care across thecontinuum, including behavioral health and long term care, formembers with high need potential. HCS staff work to ensure thatpatients progress 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 inpatient services for members to ensure optimumoutcomes, cost effectiveness and compliance with all state andfederal regulations and guidelines. Analyzes clinical service requests from members or providersagainst evidence based clinical guidelines. Identifies appropriate benefits, eligibility and expectedlength of stay for requested treatments and/or procedures. Conducts inpatient reviews to determine financialresponsibility for Molina Healthcare and its members. May alsoperform prior authorization reviews and/or related duties asneeded. Processes requests within required timelines. Refers appropriate cases to Medical Directors and presents themin a consistent and efficient manner. 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 EducationGraduate from an Accredited School ofNursing.

Required Experience3+ years hospital acute care/medicalexperience.

Required License, Certification, AssociationActive,unrestricted State Registered Nursing (RN) license in goodstanding.

Must have valid driver’s license with good driving recordand be able to drive within applicable state or locality withreliable transportation.

• 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).

Toall current Molina employees:

If you are interested in applying forthis position, please apply through the intranet job listing.

MolinaHealthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range:

$30.37

• $59.21 / HOURLY
• Actual compensation may vary from posting based on geographiclocation, work experience, education and/or skill level.