Behavioral Health Care Review Clinician, Inpatient Review (Remote)
Passport Health Plan by Molina Healthcare Louisville, Kentucky; Newport, Kentucky; Edgewood, Kentucky; Lexington-Fayette, Kentucky; Frankfort, Kentucky; Somerset, Kentucky; London, Kentucky; Georgetown, Kentucky; Bowling Green, Kentucky; Owensboro, Kentucky; Job ID 2030939Passport Health Plan by Molina Healthcare has a mission to provide quality health care to those who need it, no matter their circumstances. Today, Molina health plans serve 3,331,000 members across the country through government-funded programs. Each day, we work to earn the trust our partners and members put in us, so they can lean on Molina. Together, Passport Health Plan and Molina share a commitment to improving the health and quality of life of our members across the Commonwealth of Kentucky.
- Full Time, Part Time
- Level: All Levels
- Travel: Occassional
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Success Profile
What makes you successful at Passport Health Plan by Molina Healthcare? Check out the traits we’re looking for and see if you're the right fit!
- Compassionate
- Consultive
- Patient
- Problem-Solver
- Sincere
- Relationship Expertise
Benefits
-
Insurance
Medical · Dental · Vision
Group & Voluntary Life Insurance
Aflac · Pet Health · Identity Theft
Auto & Home Insurance -
Savings
Flexible Spending Accounts
401K · Roth 401K
Employee Stock Purchase Plan -
Career Growth
Continuing Education Units
Education Reimbursement -
Time Off
Paid Time Off
Volunteer Time Off
Company Holidays -
Additional Perks
Legal Assistance Plan
Employee Assistance & Well Being Programs
Employee Perks Platform
Rideshare Portal
Responsibilities
JOB DESCRIPTION
For this position we are seeking a Licensed Masters Level social worker with a current active license for state of KY.
The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and inpatient services for the OH Medicaid behavioral health population. Strong post-acute level of care experience (Nursing Facilities, Acute Inpatient, Rehabilitation, Long Term Acute care hospital. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good analytical thought process is important to be successful in this role. Prefer candidates that have experience doing prior authorizations for outpatient services preferrable within Behavioral Health Population.
WORK SCHEDULE: Monday thru Friday 8:00 AM to 5:00 PM EST - Training Schedule (30 to 60 days)
Permanent schedule will require you to work 4 to 5 days a week - with one weekend day required (Saturday or Sunday)
This is a Remote position, home office with internet connectivity of high speed required.
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 inpatient 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, eligibility and expected length of stay for requested treatments and/or procedures.
- Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.
- Processes requests within required timelines.
- Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
- 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.
JOB QUALIFICATIONS
Required Education
Master's Degree in Social Work, Psychology, or other Behavioral Health field
Required Experience
3+ years Behavioral Health hospital acute care/medical experience.
Required License, Certification, Association
- Active, unrestricted State license in good standing, such as LCSW, LPCC or LMFT.
- Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
Preferred Education
Master's Degree in Clinical Social Work
Preferred Experience
Recent Behavioral Health hospital experience in ICU, Medical, or ER unit.
Preferred License, Certification, Association
Active and unrestricted Licensed Clinical Social Worker
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: $25.08 - $51.49 / 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: 04/01/2025ABOUT OUR LOCATION
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