Care Review Clinician, Inpatient Review Professional

3 weeks ago


Tucson, Arizona, United States Molina Healthcare Full time

Job Summary

Molina Healthcare Services works with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum. This includes behavioral health and long-term care for members with high need potential.

The ideal candidate will have a strong background in hospital acute care and medical experience. A graduate degree from an accredited school of nursing is required, along with 3+ years of experience in a similar role.

The salary range for this position is $26.41 - $61.79 per hour, based on geographic location, work experience, education, and/or skill level. Benefits include a competitive compensation package, paid time off, and opportunities for professional growth and development.

Responsibilities:

  • Assess inpatient services to ensure optimum outcomes, cost-effectiveness, and compliance with state and federal regulations and guidelines.
  • Analyze clinical service requests against evidence-based clinical guidelines.
  • Determine financial responsibility for Molina Healthcare and its members through inpatient reviews.
  • Process requests within required timelines and collaborate with multidisciplinary teams to promote the Molina Care Model.

Requirements:

  • Active, unrestricted State Registered Nursing (RN) license in good standing.
  • Valid driver's license with a good driving record and reliable transportation.
  • Previous experience in Hospital Acute Care, ER, ICU, Prior Auth, or Utilization Review/Utilization Management.
  • Knowledge of Interqual/MCG guidelines.

About Us

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. We value diversity and inclusion in our workplace and are committed to providing equal employment opportunities for all employees and applicants.



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