Care Review Clinician, Prior Auth (RN)
Molina Healthcare Nampa, Idaho; Omaha, Nebraska; Mesa, Arizona; Utah; Wisconsin; Austin, Texas; Owensboro, Kentucky; Yonkers, New York; Tucson, Arizona; Syracuse, New York; Cleveland, Ohio; Nebraska; Ann Arbor, Michigan; Spokane, Washington; Columbus, Ohio; Florida; Covington, Kentucky; Houston, Texas; Grand Rapids, Michigan; West Valley City, Utah; Layton, Utah; Kenosha, Wisconsin; Georgia; Louisville, Kentucky; Roswell, New Mexico; Akron, Ohio; Miami, Florida; Tampa, Florida; Texas; Tacoma, Washington; Cedar Rapids, Iowa; Kearney, Nebraska; Iowa City, Iowa; Davenport, Iowa; Milwaukee, Wisconsin; Boise, Idaho; Cincinnati, Ohio; Lincoln, Nebraska; Jacksonville, Florida; Caldwell, Idaho; Rio Rancho, New Mexico; Bellevue, Nebraska; Salt Lake City, Utah; Warren, Michigan; Orem, Utah; Savannah, Georgia; Green Bay, Wisconsin; Sioux City, Iowa; Washington; Scottsdale, Arizona; Rochester, New York; Phoenix, Arizona; Chandler, Arizona; Racine, Wisconsin; Idaho Falls, Idaho; Santa Fe, New Mexico; Atlanta, Georgia; Sterling Heights, Michigan; Meridian, Idaho; Detroit, Michigan; Idaho; Des Moines, Iowa; Fort Worth, Texas; Augusta, Georgia; Macon, Georgia; Dallas, Texas; Vancouver, Washington; Madison, Wisconsin; Kentucky; Albuquerque, New Mexico; San Antonio, Texas; Provo, Utah; Las Cruces, New Mexico; Orlando, Florida; Columbus, Georgia; Iowa; Grand Island, Nebraska; Michigan; Lexington-Fayette, Kentucky; Bowling Green, Kentucky; Dayton, Ohio; St. Petersburg, Florida; Bellevue, Washington; Buffalo, New York; New York; New Mexico; Ohio Job ID 2029363JOB DESCRIPTION
Job Summary
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
KNOWLEDGE/SKILLS/ABILITIES
- Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
- Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
- Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
- Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
- Processes requests within required timelines.
- Refers appropriate prior authorization requests to Medical Directors.
- Requests additional information from members or providers in consistent and efficient manner.
- Makes appropriate referrals to other clinical programs.
- Collaborates with multidisciplinary teams to promote Molina Care Model
- Adheres to UM policies and procedures.
- Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
- Must be able to travel within applicable state or locality with reliable 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 good standing.
Preferred Experience
Previous experience in hospital Acute care, ER or ICU
Previous experience with InterQual or MCG guidelines
Work schedule: Mon - Fri daytime hours, some weekends and holidays required for all shifts.Â
**PACIFIC DAYTIME BUSINESS HOURSÂ
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. 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 geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 12/18/2024ABOUT OUR LOCATION
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