CARE REVIEW CLINICIAN, INPATIENT REVIEW

1 month ago


Long Beach CA USA, United States Molina Healthcare Full time
**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.

**We are seeking a candidate with a LPN/LVN licensure with** **2 years of acute/post acute experience.** **Further details to be discussed during our interview process.**

**Remote position preferably on the West Coast.**

**Work schedule M-F 8:30 AM to 5:00 PM PST.**

**KNOWLEDGE/SKILLS/ABILITIES**

+ Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

+ 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.

+ Under the direction of a Registered Nurse, identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

+ 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**

Graduate from an Accredited School of Nursing. Associate degree in Nursing preferred.

**Required Experience**

3+ years hospital acute care/medical experience.

**Required License, Certification, Association**

Active, unrestricted State Licenses Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) license in good standing.

**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 Experience**

Recent hospital experience in Medical or ER unit.

**2 years of acute/post acute experience.**

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: $21.6 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

  • Long Beach, United States Molina Healthcare Full time

    Job DescriptionJOB DESCRIPTIONCare Review Clinician, Inpatient Review- Behavioral HealthFor this position we are seeking a LPC or LCSW who lives in and must be licensed for the state they reside. Strong inpatient medical and analytical experience is needed. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role....


  • Long Beach, United States Molina Healthcare Full time

    Job DescriptionJOB DESCRIPTIONCare Review Clinician, Inpatient Review- Behavioral HealthFor this position we are seeking a LPC or LCSW who lives in and must be licensed for the state they reside. Strong inpatient medical and analytical experience is needed. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role....


  • Long Beach, United States Molina Healthcare Full time

    **JOB DESCRIPTION** Care Review Clinician, Inpatient Review- Behavioral Health For this position we are seeking a LPC or LCSW who lives in and must be licensed for the state they reside. Strong inpatient medical and analytical experience is needed. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good...


  • Long Beach, United States Molina Healthcare Full time

    **JOB DESCRIPTION** Care Review Clinician, Inpatient Review- Behavioral Health For this position we are seeking a LPC or LCSW who lives in and must be licensed for the state they reside. Strong inpatient medical and analytical experience is needed. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good...


  • Long Beach, United States Molina Healthcare Full time

    **JOB TITLE**: CARE REVIEW CLINICIAN INPATIENT REVIEW : LICENSED VOCATIONAL NURSE, CALIFORNIA LICENSED For this position we are seeking a (LVN) Licensed Vocational Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. CALIFORNIA LICENSURE IS REQUIRED FOR THIS...


  • Long Beach, United States Molina Healthcare Full time

    **JOB TITLE**: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. CALIFORNIA LICENSURE IS REQUIRED FOR THIS ROLE IMMEDIATELY UPON HIRE. CALIFORNIA...


  • Long Beach, United States Molina Healthcare Full time

    For this position it will be helpful to have previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and prior knowledge of Interqual / MCG guidelines. Basic knowledge of Utilization Management processes desired. COMPACT LICENSURE IS REQUIRED to support multiple states. Further Details to be discussed during our...


  • Long Beach, United States Molina Healthcare Full time

    For this position we are seeking a California (RN) Registered Nurse with 3 years+ Concurrent Review/ Utilization Review / Utilization Management and must have Interqual, and MCG guidelines experience. CURRENT RN CALIFORNIA LICENSURE IS REQUIRED FOR THIS POSITION. California is not a compact state at this time. This department operates 365 days a year and we...


  • Long Beach, United States Molina Healthcare Full time

    For this position we are seeking a California (RN) Registered Nurse with 3 years+ Concurrent Review/ Utilization Review / Utilization Management and must have Interqual, and MCG guidelines experience. CURRENT RN CALIFORNIA LICENSURE IS REQUIRED FOR THIS POSITION. California is not a compact state at this time. This department operates 365 days a year and we...


  • Long Beach, United States Molina Healthcare Full time

    For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. COMPACT RN LICENSURE IS PREFERABLE to support multiple states. **WORK HOURS**: : 5 days / daytime work schedule 8:30AM to 5:30PM This department operates...


  • Long Beach, United States Molina Healthcare Full time

    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...


  • Long Beach, United States Molina Healthcare Full time

    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...


  • Long Beach, United States Molina Healthcare Full time

    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...


  • Long Beach, United States Saviance Technologies Full time

    Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior...


  • Long Beach, United States Saviance Technologies Full time

    Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior...


  • Long Beach, United States Molina Healthcare Full time

    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...


  • Long Beach, United States Molina Healthcare Full time

    **DEPARTMENT FUNCTION**: PRIOR AUTH, ADVANCED IMAGING **WORK HOURS**: 5 days / daytime work schedule TUESDAY THRU SATURDAY **OR** SUNDAY THRU THURSDAY Further Details to be discussed during our interview process. Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and...


  • Long Beach, United States Molina Healthcare Full time

    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...


  • Long Beach, United States Molina Healthcare Full time

    **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...


  • Long Beach, United States Molina Healthcare Full time

    **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...