Remote Care Review Clinician,
Found in: beBee jobs US - 2 weeks ago
JOB DESCRIPTION
Opportunity for a Nebraska licensed RN to complete Inpatient and Outpatient Utilization Reviews for our behavioral health members. Preference will be given to those nurses who have experience doing these types of reviews within another Managed Care Organization and has experience working with behavioral health patients. This is a fully remote position, working from home, Monday – Friday, 8 AM – 5 PM CST and the opportunity is open to all qualified applicants who reside in Nebraska.
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
Graduate from an Accredited School of Nursing.
Required Experience
3+ years hospital acute care/medical experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
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
Preferred Education
Bachelor's Degree in Nursing
Preferred Experience
Recent hospital experience in ICU, Medical, or ER unit.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
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: $ $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
-
Project Engineer
Found in: Resume Library US A2 - 1 week ago
Omaha, Nebraska, United States Olsson Full timeJob Description As a Project Engineer for Olsson’s Rail Track Team, you will be responsible for a wide variety of tasks including track & civil design, project execution, quality control reviews, scheduling, estimating, and potential travel for projects. You will coordinate projects with other Olsson teams, perform and coordinate design aspects of...
-
CRNA Locums
Found in: Jooble US O C2 - 3 hours ago
Nebraska, United States LocumTenens.com Full timecom is seeking a CRNA Anesthesia for a locum tenens job in Southern, Nebraska. Employment Type: Locum Tenens A large hospital is seeking a CRNA for locum tenens coverage. The facility is located in southern Nebraska. The schedule is Monday - Friday ranging between 6:00 am and 8:00 am to 2:30 pm and 4:30 pm. The cases include OB, Neuro, General,...
-
Remote Case Manager
Found in: beBee jobs US - 1 week ago
Nebraska, United States Molina Healthcare Full timeJOB DESCRIPTIONOpportunity for a Nebraska licensed RN with experience with Substance Abuse Disorder to join our Health Plan as a Case Manager. While there may be a need to conduct a face-to-face meeting with members in your area, most of the work will be telephonic. This is open to all qualified applicants who reside in Nebraska.Schedule is Monday –...
-
Locum Tenens CRNA
Found in: Jooble US O C2 - 3 hours ago
Nebraska, United States LocumTenens.com Full timeLocumTenens.com is seeking a CRNA Anesthesia for a locum tenens job in Southern, Nebraska. Job Description & Requirements Specialty: Anesthesia Discipline: CRNA Duration: 13 weeks Employment Type: Locum Tenens A large hospital is seeking a CRNA for locum tenens coverage. The facility is located in southern Nebraska. The schedule is Monday -...
-
Full-Time, Part-Time and PRN Hospitalist in Scottsbluff, Nebraska
Found in: beBee jobs US - 1 week ago
Nebraska, United States TeamHealth Full timeTeamHealth is seeking a hospitalist physician to join our prestigious practice at Regional West Medical Center in Scottsbluff, Nebraska. Qualified candidates must be board certified/board eligible in internal medicine or board certified in family practice with experience.This program features:Level II Trauma Center188-bed facility28-bed ICUGME program5...
-
Project Engineer
Found in: Resume Library US A2 - 1 week ago
Lincoln, Nebraska, United States Olsson Full timeJob Description As a Project Engineer on the Water Resources team, you will provide various engineering and project management duties related to hydrologic/hydraulic analysis for Class I Railroad projects. You will assist with developing the project scope and schedule, prepare technical reports, review CAD drawings, and obtain local, state, and federal...
-
Clinical Psychologist
Found in: Jooble US O C2 - 1 day ago
Nebraska, United States MRG Exams Full timeProviding Disability Assessments Nationwide To Serve Our Veterans Help Military Families – Achieve Work-Life Balance – Make a Difference Founded in 1998, MRG is a provider of Independent Medical Exams for Worker’s Compensation, Disability, and the Veterans Administration. Are you interested in performing Independent Medical Assessments vs....
-
Billing Rep
Found in: Resume Library US A2 - 10 hours ago
Lincoln, Nebraska, United States CommonSpirit Health Full timeOverview: CHI Health strives to care for you the way you care for your patients. We understand you have personal responsibilities outside of your profession and also care about your well-being. With you in mind, we offer the following benefits to support your work/life balance: Health/Dental/Vision Insurance Direct Primary Plan (No copay,...
-
Clinical Psychologist
Found in: Jooble US O C2 - 28 minutes ago
Nebraska, United States MRG Exams Full timeMRG Exams Providing Disability Assessments Nationwide To Serve Our Veterans Help Military Families – Achieve Work-Life Balance – Make a Difference Founded in 1998, MRG is a provider of Independent Medical Exams for Worker’s Compensation, Disability, and the Veterans Administration. Find out more at MRGExams.com. Job Overview Are you a Licensed...
-
Clinical Psychologist
Found in: Jooble US O C2 - 26 minutes ago
Nebraska, United States MRG Exams Full timeMRG Exams Providing Disability Assessments Nationwide To Serve Our Veterans Help Military Families – Achieve Work-Life Balance – Make a Difference Founded in 1998, MRG is a provider of Independent Medical Exams for Worker’s Compensation, Disability, and the Veterans Administration. Find out more at MRGExams.com. Job Overview Are you a Licensed...
-
Clinical Psychologist
Found in: Jooble US O C2 - 1 day ago
Nebraska, United States MRG Exams Full timeMRG Exams Providing Disability Assessments Nationwide To Serve Our Veterans Help Military Families – Achieve Work-Life Balance – Make a Difference Founded in 1998, MRG is a provider of Independent Medical Exams for Worker’s Compensation, Disability, and the Veterans Administration. Find out more at MRGExams.com. Job Overview Are you a Licensed...
-
Communications Rep
Found in: Resume Library US A2 - 2 weeks ago
Lincoln, Nebraska, United States CommonSpirit Health Full timeOverview: Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger communities. CHI Health...
-
Coder II
Found in: Resume Library US A2 - 1 week ago
Omaha, Nebraska, United States CommonSpirit Health Full timeOverview: REMOTE WORK OPPORTUNITY Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger...
-
Financial Counselor
Found in: Resume Library US A2 - 1 week ago
Omaha, Nebraska, United States CommonSpirit Health Full timeOverview: REMOTE WORK OPPORTUNITY Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger...
-
Environmental Svcs Tech
Found in: Resume Library US A2 - 2 weeks ago
Lincoln, Nebraska, United States CommonSpirit Health Full timeOverview: Eligible for a $1,500 Sign on Bonus CHI Health Nebraska Heart delivers leading-edge services to Nebraska and northern Kansas. Our network of offices and affiliated hospital-based clinics enables patients to receive timely care close to home. In addition Nebraska Heart located in southeast Lincoln has dramatically reshaped the way in which...
-
CV Sonographer II
Found in: Resume Library US A2 - 1 week ago
Lincoln, Nebraska, United States CommonSpirit Health Full timeOverview: CHI Health Nebraska Heart delivers leading-edge services to Nebraska and northern Kansas. Our network of offices and affiliated hospital-based clinics enables patients to receive timely care close to home. In addition Nebraska Heart located in southeast Lincoln has dramatically reshaped the way in which patients receive care. Nebraska Heart...
-
Insurance Follow Up Rep
Found in: Resume Library US A2 - 1 week ago
Omaha, Nebraska, United States CommonSpirit Health Full timeOverview: REMOTE WORK OPPORTUNITY Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger...
-
Nursing Supervisor
Found in: Resume Library US A2 - 2 days ago
Kearney, Nebraska, United States CommonSpirit Health Full timeOverview: This position contributes to the Mission and Vision of CHI Health by serving as a supervisor with oversight of the day to day activities of their operations and team members. Provides management support to plan, organize and lead resources with assigned team members; as well as functioning as an individual contributor within the department. ...
-
Registered Nurse Pre Assessment Testing
Found in: Resume Library US A2 - 2 weeks ago
Omaha, Nebraska, United States SCA Health Full timeOverview: Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality...
-
Student Nurse Technician
Found in: Resume Library US A2 - 10 hours ago
Lincoln, Nebraska, United States CommonSpirit Health Full timeOverview: Job Summary / Purpose: This job is responsible for providing nursing care and support to patients under the direction of a Registered Nurse (RN) in a defined care team and in accordance with assigned tasks and permitted by the Nursing Skills Checklist, with the exception of administering medication. An incumbent assumes responsibility for...