Inpatient Review Clinician
1 month ago
**EMERGENCY ROOM ADMISSIONS REVIEW NURSE**
**_PERMANENT SHIFT WILL BE :_** **_12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS NON EXEMPT, 3 days a week will rotate._**
**_Candidates can live anywhere in the USA if they have a valid CALIFORNIA RN license; must work the shift hours as posted. Out of state candidates will work PACIFIC HOURS._**
**_TRAINING SCHEDULE WILL BE Monday thru Friday 8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift after training is completed._**
**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**
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:**
CA Qualifications: Current licensure for the state of California is required
**Preferred Education**
Bachelor's Degree in Nursing
**Preferred Experience**
Recent hospital experience in ICU, Medical, or ER unit.
Recent experience with InterQual, or MCG guidelines
**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: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
-
Skilled Therapist Opportunity in Ventura, CA
1 month ago
Ventura, California, United States Ensign Therapy Full timeCompany Overview: Victoria Care Center is a reputable Skilled Nursing Facility known for its upscale Danish aesthetic and commitment to providing exceptional care. Our therapy staff is the backbone of our facility, and we take pride in fostering a positive work environment where clinicians are respected and valued.Salary: This Full Time PTA position offers a...
-
Licensed Physical Therapist Assistant – Full-Time
5 months ago
Ventura, United States South Pacific Rehab Services Full timeOverview: Must be a licensed and or a registered therapist to be considered. Skilled Nursing Facility Setting** EXCLUSIVE NEW JOB OPPORTUNITY!!** ***Highly competitive rates and benefits package! *** Do you know a therapist who's a perfect fit for our team? EARN UP TO $1,000 by referring a clinician to the Enhance family of brands! Make a difference and...
-
Case Manager Utilization RN, 40/hr Day
4 months ago
Ventura, United States HealthEcareers - Client Full timeSign On Bonus in Eligible External HiresJob Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and...
-
Case Manager Utilization RN, 40/hr Day
2 months ago
Ventura, United States Kaiser Permanente Full timeSign On Bonus for Eligible External Hires Job Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient...
-
Ventura, United States Kaiser Permanente Full timeSign On Bonus for Eligible External Hires Job Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient...
-
Case Manager Utilization RN
2 months ago
Ventura, United States Kaiser Permanente Full timeJob Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a safe...
-
VENTURA, United States Guidehouse Full timeJob Family:Patient Account RepresentativeTravel Required:Up to 10%Clearance Required:NoneWhat You Will Do:The Admitting Representative is Onsite at Community Memorial Hospital in Ventura, CA.• Provides excellent customer service to all individuals.• Perform accurate registration, arrival, and check-in functions upon a patient presenting...
-
VENTURA, United States Guidehouse Full timeJob Family:Admitting RepresentativeTravel Required:Up to 10%Clearance Required:NoneWhat You Will Do:The Admitting Representative is ONSITE at Community Memorial Hospital in Ventura, CA.• Provides excellent customer service to all individuals.• Perform accurate registration, arrival, and check-in functions upon a patient presenting themselves...
-
Part Time Admitting Day Shift
1 month ago
VENTURA, United States Guidehouse Full timeJob Family:Admitting RepresentativeTravel Required:Up to 10%Clearance Required:NoneWhat You Will Do:Provides excellent customer service to all individuals.Perform accurate registration, arrival, and check-in functions upon a patient presenting themselves for service.Collect all necessary patient, demographic, and insurance information/documentation to ensure...
-
Part Time Admitting Day Shift Emergency Room
4 months ago
VENTURA, United States Guidehouse Full timeJob Family:Admitting RepresentativeTravel Required:Up to 10%Clearance Required:NoneWhat You Will Do:Provides excellent customer service to all individuals.Perform accurate registration, arrival, and check-in functions upon a patient presenting themselves for service.Collect all necessary patient, demographic, and insurance information/documentation to ensure...
-
Occupational Therapist
2 months ago
Ventura, United States Omni Therapy Full timeOccupational Therapist (OT) for Home Health Omni Therapy in Ventura, Ca. Professional Opportunity Details: Omni Therapy is looking for a contract Occupational Therapist (OT) to evaluate and treat patients in their homes in Ventura, Ca. Did You Know? Omni Therapy gives you complete control over your work schedule and accept or decline patients without...
-
Physical Therapist
2 months ago
Ventura, United States Omni Therapy Full timePhysical Therapist (PT) for Home Health Omni Therapy in Ventura, Ca. Professional Opportunity Details: Omni Therapy is looking for a contract Physical Therapist (PT) to evaluate and treat patients in their homes in the Ventura, Ca. area. Did You Know? Omni Therapy gives you complete control over your work schedule and accept or decline patients without...
-
NP or PA Home Visits
3 months ago
Ventura, United States Optum Full time$40,000 Student Loan Repayment Or $20,000 Sign-on Bonus For Individuals Who Have Not Previously Participated In This Program Landmark, part of the Optum family of businesses, is seeking a NP Home Visits to join our team in San Fernando Valley, CA. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of...
-
Center Based Behavior Technician
4 months ago
Ventura, United States The Stepping Stones Group Full timeABA Center-Based Behavior Technician Let us help you shape your new career, one step at a time! Do you enjoy working with kids? Are you seeking a new career in healthcare with a stable, expanding company that truly values and supports its team members? Community Autism Services, a division of The Stepping Stones Group, is urgently hiring for Behavior...
-
Pre-Registration Coordinator
3 weeks ago
VENTURA, United States Guidehouse Full timeJob Family:Admitting RepresentativeTravel Required:NoneClearance Required:NoneWhat You Will Do:The Pre-Admitting Coordinator is responsible for obtaining precertification, and/or validating prior authorization statuses in support of insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient),...
-
ventura county, United States Clinicas del Camino Real, Inc. Full timeDuties:Open to Full Time or Part Time availability.The Licensed Marriage and Family Therapist provides patient-centered care addressing mental health conditions to individuals and families. Works with a multi-cultural population of diverse socioeconomic backgrounds and ages in a multi-disciplinary healthcare environment. Works under the supervision of the...
-
Licensed Marriage And Family Therapist
3 days ago
Ventura County, United States Clinicas del Camino Real, Inc. Full timeDuties:Open to Full Time or Part Time availability.The Licensed Marriage and Family Therapist provides patient-centered care addressing mental health conditions to individuals and families. Works with a multi-cultural population of diverse socioeconomic backgrounds and ages in a multi-disciplinary healthcare environment. Works under the supervision of the...
-
Licensed Marriage And Family Therapist
4 days ago
Ventura County, United States Clinicas del Camino Real, Inc. Full timeDuties:Open to Full Time or Part Time availability.The Licensed Marriage and Family Therapist provides patient-centered care addressing mental health conditions to individuals and families. Works with a multi-cultural population of diverse socioeconomic backgrounds and ages in a multi-disciplinary healthcare environment. Works under the supervision of the...
