CARE REVIEW CLINICIAN, INPATIENT REVIEW (RN)
Company: Molina Healthcare
Location: Kenosha
Posted on: October 11, 2024
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Job Description:
JOB DESCRIPTIONPreferred schedule Tuesday through Saturday.Job
SummaryMolina 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/ABILITIESAssesses
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.Ability
to cross train across roles, IP Medical to PA Medical or IP Medical
to BH PA Medical.JOB QUALIFICATIONSRequired EducationGraduate from
an Accredited School of Nursing.Required Experience3+ years
hospital acute care/medical experience.Required License,
Certification, AssociationActive, 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.State
Specific Requirements:IL Qualifications: Licensed within the state
of Illinois or will apply for licensure within the state of
Illinois within 30 days of employmentPreferred EducationBachelor's
Degree in NursingPreferred ExperienceRecent hospital experience in
ICU, Medical, or ER unit.Preferred License, Certification,
AssociationActive, unrestricted 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.Pay Range: $23.76 - $51.49 /
HOURLY*Actual compensation may vary from posting based on
geographic location, work experience, education and/or skill
level.
Keywords: Molina Healthcare, Gary , CARE REVIEW CLINICIAN, INPATIENT REVIEW (RN), Healthcare , Kenosha, Indiana
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