Care Review Clinician, Inpatient Review (RN)
Company: Molina Healthcare
Location: Irving
Posted on: January 10, 2021
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Job Description:
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. Preferred Education
Bachelor's Degree in Nursing Preferred Experience Recent hospital
experience in ICU, Medical, or ER unit. Preferred License,
Certification, Association 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.
Keywords: Molina Healthcare, Irving , Care Review Clinician, Inpatient Review (RN), Healthcare , Irving, Texas
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