Care Review Clinician, Inpatient Review (RN) Position Available In Chatham, Georgia

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 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 of Nursing

• Required Experience3+ years hospital acute care/medical experience
• 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
• Actual compensation may vary from posting based on geographiclocation, work experience, education and/or skill level.