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Care Review Clinician, Inpatient Review (BH)

Passport Health Plan by Molina Healthcare

Louisville, Kentucky;

Job ID 2033438

Apply now

Overview

Passport 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.

Experienced professionals and new grads are encouraged to apply.

Full Time
Level: Mid-Level
Travel: Yes

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 Benefits

Legal Assistance Plan Employee Assistance & Well Being Programs Employee Perks Platform Rideshare Portal

RESPONSIBILITIES

JOB 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 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.
Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

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.

State Specific Requirements:

IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment. Master’s Degree in Social Work, Psychology, or other Behavioral Health field, or graduate from an accredited School of Nursing. Active, unrestricted State license in good standing, such as LCSW, LPCC, LMFT or RN.

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 10/01/2025