IrvingRecruiter Since 2001
the smart solution for Irving jobs

Care Review Clinician, Inpatient Review

Company: Molina Healthcare
Location: Irving
Posted on: November 20, 2020

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, Other , Irving, Texas

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Deliver with Uber Eats this Fall
Description: Deliver with Uber Eats this Fall Tyler, TX 2854 C2-720704 Deliver with Uber. Earn on your schedule. Work on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends it's (more...)
Company: Uber Eats
Location: Tyler
Posted on: 12/2/2020

Patient Care Tech, Neuro IMC, Full Time, 7A-7P
Description: Advancing Healthcare Together - The Future of Healthcare is in East Texas br br Why UT Health - East Texas br br Our People. Our people truly are our greatest strength. They make a massive difference (more...)
Company: UT Health Tyler
Location: Tyler
Posted on: 12/2/2020

ED Tech - Emergency Care Center
Description: Job Description Description Summary: This is a PRN position: no set
Company: CHRISTUS Health
Location: Tyler
Posted on: 12/2/2020


Merchandise Associate
Description: Responsible for delivering a highly satisfied customer experience demonstrated by engaging and interacting with all customers, embodying customer experience principals and philosophy, and maintaining (more...)
Company: HomeGoods
Location: Tyler
Posted on: 12/2/2020

Deliver with Uber Eats
Description: Deliver with Uber Eats Tyler, TX 2854 C2-197947 Deliver with Uber. Earn on your schedule. Work on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends it's up to (more...)
Company: Uber Eats
Location: Tyler
Posted on: 12/2/2020

Client Care Coordinator/.Scheduler
Description: Job Description Conduct Care Consultations with potential Clients and
Company: Home Instead
Location: Tyler
Posted on: 12/2/2020

Earn more this Fall, deliver with Uber Eats
Description: Earn more this Fall, deliver with Uber Eats Tyler, TX 2854 C2-756728 Deliver with Uber. Earn on your schedule. Work on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends (more...)
Company: Uber Eats
Location: Tyler
Posted on: 12/2/2020

Earn cash this Fall. Deliver with Uber
Description: Earn cash this Fall. Deliver with Uber Tyler, TX 2854 C2-744722 Deliver with Uber. Earn on your schedule. Work on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends (more...)
Company: Uber Eats
Location: Tyler
Posted on: 12/2/2020

Licensed Automotive Inspector
Description: Geared for the Driven During these uncertain times of COVID-19, Valvoline Instant Oil Change SM VIOC is proud to serve those who need to be on the road, including first responders and medical workers (more...)
Company: Valvoline Instant Oil Change
Location: Tyler
Posted on: 12/2/2020

Laundry Tech
Description: Job Description
Company: CHRISTUS Health
Location: Tyler
Posted on: 12/2/2020

Log In or Create An Account

Get the latest Texas jobs by following @recnetTX on Twitter!

Irving RSS job feeds