Inpatient Utilization Review Clinician

2 days ago


Covington, Kentucky, 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, including behavioral health and long term care, for members with high need potential.

The Inpatient Utilization Review Clinician ensures 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.

About This Role

This role operates 365 days a year, requiring flexibility and willingness to work holidays. The position involves multitasking between systems, communicating with members on the phone, and entering accurate contact notes.

Able to cross train across roles, this Inpatient Utilization Review Clinician will promote Molina Care Model through collaboration with multidisciplinary teams.

Key Responsibilities
  1. Assesses inpatient services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state and federal regulations and guidelines.
  2. Analyzes clinical service requests from members or providers against evidence-based clinical guidelines.
  3. Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
  4. Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members.
  5. Processes requests within required timelines.
Requirements

To succeed in this role, you will need:

  • 3+ years hospital acute care/medical experience.
  • Graduate from an Accredited School of Nursing.
  • Active, unrestricted Wisconsin Registered Nursing (RN) license in good standing.
  • Valid driver's license with good driving record and ability to drive within applicable state or locality with reliable transportation.
Benefits and Compensation

Molina Healthcare offers a competitive $26.41 - $51.49 / HOURLY compensation package, along with a range of benefits and opportunities for professional growth.



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