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Care Review Clinician, Inpatient Review

1 month ago


Florence, Colorado, United States Molina Healthcare Full time

pstrongJobSummary/strong/ppMolinaHealthcareServices(HCS)isseekingaskilledstrongCareReviewClinician,InpatientReview/strongtojoinourteam.Asakeymemberofourmultidisciplinaryteam,youwillworkcloselywithmembers,providers,andotherhealthcareprofessionalstoassess,facilitate,plan,andcoordinateanintegrateddeliveryofcareacrossthecontinuum./ppstrongKeyResponsibilities/strong/pulliAssessinpatientservicesformemberstoensureoptimumoutcomes,cost-effectiveness,andcompliancewithstateandfederalregulationsandguidelines./liliAnalyzeclinicalservicerequestsfrommembersorprovidersagainstevidence-basedclinicalguidelines./liliIdentifyappropriatebenefits,eligibility,andexpectedlengthofstayforrequestedtreatmentsand/orprocedures./liliConductinpatientreviewstodeterminefinancialresponsibilityforMolinaHealthcareanditsmembers./liliProcessrequestswithinrequiredtimelines./liliRefersappropriatecasestoMedicalDirectorsandpresentstheminaconsistentandefficientmanner./liliMakesappropriatereferralstootherclinicalprograms./liliCollaborateswithmultidisciplinaryteamstopromoteMolinaCareModel./liliAdherestoUMpoliciesandprocedures./li/ulpstrongRequirements/strong/pulliGraduatefromanAccreditedSchoolofNursing./lili3+yearshospitalacutecare/medicalexperience./liliActive,unrestrictedStateRegisteredNursing(RN)licenseingoodstanding./liliValiddriver'slicensewithgooddrivingrecordandabilitytodrivewithinapplicablestateorlocalitywithreliabletransportation./li/ulpstrongPreferredQualifications/strong/pulliBachelor'sDegreeinNursing./liliRecenthospitalexperienceinICU,Medical,orERunit./liliActive,unrestrictedUtilizationManagementCertification(CPHM)./li/ulpstrongAboutMolinaHealthcare/strong/ppMolinaHealthcareisanEqualOpportunityEmployer(EOE)M/F/D/V.Weofferacompetitivebenefitsandcompensationpackage./p