Care Review Clinician
7 hours ago
Care Review Clinician Inpatient Review Bh The care review clinician inpatient review bh will provide prior authorization for outpatient and inpatient services for the ky medicaid behavioral health population. Strong post-acute level of care experience (nursing facilities, acute inpatient, rehabilitation, long term acute care hospital, behavioral health facility. 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, sunday (either one or both)) this is a remote position, home office with internet connectivity of high speed required. job summary provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. essential job duties assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/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 reviews to determine prior authorization/financial responsibility for molina and its members. processes requests within required timelines. refers appropriate cases to medical directors (mds) and presents them in a consistent and efficient manner. requests additional information from members or providers as needed. makes appropriate referrals to other clinical programs. collaborates with multidisciplinary teams to promote the molina care model. adheres to utilization management (um) policies and procedures. required qualifications at least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. registered nurse (rn). License must be active and unrestricted in state of practice. ability to prioritize and manage multiple deadlines. excellent organizational, problem-solving and critical-thinking skills. strong written and verbal communication skills. microsoft office suite/applicable software program(s) proficiency. preferred qualifications certified professional in healthcare management (cphm). recent hospital experience in an intensive care unit (icu) or emergency room. 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.
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Cedar Rapids, United States Mpac, Llc Full timeA healthcare provider in Cedar Rapids is looking for Licensed Clinicians (LPC, LMFT, LCSW) to provide quality, patient-centered care for seniors. This role offers flexibility, a supportive work culture, and opportunities for career growth. Ideal candidates will have a master's degree, a valid license, and extensive experience in interdisciplinary...
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Nurse Clinician
3 days ago
Cedar Rapids, United States PROMPT CARE COMPANIES INC Full timeJob TypeFull-timeDescriptionPromptcare is seeking experienced and compassionate Registered Home Infusion Nurses to join our team of healthcare professionals. As a Registered Home Infusion Nurse, you will be responsible for providing specialized nursing care to patients in their homes. You will be responsible for assessing, planning, implementing, and...
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Nurse Clinician
2 days ago
Cedar Rapids, IA, United States PROMPT CARE COMPANIES INC Full timeJob Type Full-time Description Promptcare is seeking experienced and compassionate Registered Home Infusion Nurses to join our team of healthcare professionals. As a Registered Home Infusion Nurse, you will be responsible for providing specialized nursing care to patients in their homes. You will be responsible for assessing, planning, implementing, and...
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Nurse Clinician
2 weeks ago
Cedar Rapids, IA, United States PROMPT CARE COMPANIES INC Full timeJob Type Full-time Description Promptcare is seeking experienced and compassionate Registered Home Infusion Nurses to join our team of healthcare professionals. As a Registered Home Infusion Nurse, you will be responsible for providing specialized nursing care to patients in their homes. You will be responsible for assessing, planning, implementing, and...
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Nurse Clinician
6 days ago
Cedar Rapids, IA, United States PROMPT CARE COMPANIES INC Full timeJob Type Full-time Description Promptcare is seeking experienced and compassionate Registered Home Infusion Nurses to join our team of healthcare professionals. As a Registered Home Infusion Nurse, you will be responsible for providing specialized nursing care to patients in their homes. You will be responsible for assessing, planning, implementing, and...
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Nurse Clinician
1 week ago
Cedar Rapids, IA, United States PROMPT CARE COMPANIES INC Full timeJob Type Full-time Description Promptcare is seeking experienced and compassionate Registered Home Infusion Nurses to join our team of healthcare professionals. As a Registered Home Infusion Nurse, you will be responsible for providing specialized nursing care to patients in their homes. You will be responsible for assessing, planning, implementing, and...
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Nurse Clinician
1 week ago
Cedar Rapids, IA, United States PROMPT CARE COMPANIES INC Full timeJob Type Full-time Description Promptcare is seeking experienced and compassionate Registered Home Infusion Nurses to join our team of healthcare professionals. As a Registered Home Infusion Nurse, you will be responsible for providing specialized nursing care to patients in their homes. You will be responsible for assessing, planning, implementing, and...
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Lead Clinician
10 hours ago
Cedar Rapids, United States Sono Bello Full timeLead Clinician (RN) Sono Bello is America's top cosmetic surgery specialist, with 185+ board-certified surgeons who have performed over 300,000 laser liposuction and body contouring procedures. A career at Sono Bello means being part of a dynamic and high-energy work environment where every team member can make a difference. We love what we do, and it shows!...
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Lead Clinician
3 hours ago
Cedar Rapids, Iowa, United States Sono Bello Full timeSono Bello is America's top cosmetic surgery specialist, with 185+ board-certified surgeons who have performed over 300,000 laser liposuction and body contouring procedures. A career at Sono Bello means being part of a dynamic and high-energy work environment where every team member can make a difference. We love what we do, and it shows We believe everyone...
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Licensed Clinician
5 days ago
Cedar Rapids, United States MPAC HealthCare Full timeMPAC Healthcare has been named one of Crain’s Best Places to Work 2021 and Great Place to Work Certified!! Our team is hardworking, fun-loving, and dedicated to patient-centered care….come join us! MPAC Healthcare is looking for Licensed Clinicians (LMHC, LMFT, LISW) who are excited to set a new bar for the quality of care provided to seniors....
