Care Review Clinician, PA (RN) – Transplant Team – Compact License Position Available In Orange, Florida

Job Description:

JOB DESCRIPTION

Opportunity for experienced Utilization Review RN in United Stateswho has a compact, multi-state license. This team reviews the priorauthorization requests for transplants; the ideal candidate willhave experience either in utilization review or case management fortransplants.

• Preference will be given to those whose UM experienceis within another MCO like Molina; experience with Interqual/MCGguidelines is needed.
• Excellent computer, multi-tasking skills,and analytical thought processes are vital to be successful in thisrole. Productivity is important with specific turnaround times thatmust be met.
• Preference will be given to candidates who are willing to work PSTschedule M
• F and there may also be weekend and/or holidaycoverage due to business needs.
• Solid experience with Microsoft Office Suite is necessary,especially with Outlook, Excel, Teams, and One Note.

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. Must be able to travel within applicable state or locality withreliable transportation as required for internal meetings.

JOB QUALIFICATIONS

Required Education Completion of an accredited Registered Nurse (RN). Required Experience 1-3 years of hospital or medical clinic experience. Required License, Certification, Association Active, unrestricted State Registered Nursing (RN) license in goodstanding.

• 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:

$26.41

• $61.79 / HOURLY
• Actual compensation may vary from posting based on geographiclocation, work experience, education and/or skill level.