Care Review Clinician, Inpatient Review (RN) Position Available In Leon, Florida

Job Description:

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 optimum outcomes,cost effectiveness and compliance with all state and federalregulations and guidelines. Analyzes clinical service requests from members or providersagainst evidence based clinical guidelines. Identifies appropriate benefits, eligibility and expected length ofstay for requested treatments and/or procedures. Conducts inpatient reviews to determine financial responsibilityfor Molina Healthcare and its members. May also perform priorauthorization reviews and/or related duties as needed. Processes requests within required timelines. Refers appropriate cases to Medical Directors and presents them ina consistent and efficient manner. Requests additional information from members or providers inconsistent and efficient manner. Makes appropriate referrals to other clinical programs. Collaborates with multidisciplinary teams to promote Molina CareModel. 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, unrestrictedState Registered Nursing (RN) license in good standing.

Must havevalid driver’s license with good driving record and be able todrive within applicable state or locality with reliabletransportation. 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).

MULTI STATE / COMPACT LICENSURE WORK SCHEDULE

Mon

• Fri / Sun
• Thurs / Tues
• Sat shift willrotate with some weekends and holidays.

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 andcompensation package. Molina Healthcare is an Equal OpportunityEmployer (EOE) M/F/D/V.

Pay Range:

$26.41

• $51.49 / HOURLY
• Actualcompensation may vary from posting based on geographic location,work experience, education and/or skill level.