RN Care Review Clinician - UM/Discharge Planning
M
Molina HealthcareHealthcare
United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- At least 2 years
- Required Skills
- Microsoft Office
Requirements
- Registered Nurse (RN) license, must be active and unrestricted in state of practice.
- At least 2 years of experience in hospital acute care, inpatient review, prior authorization, or managed care.
- Ability to prioritize and manage multiple deadlines.
- Strong organizational, problem-solving, and critical-thinking skills.
- Proficiency with Microsoft Office suite and applicable software programs.
- Certified Professional in Healthcare Management (CPHM) preferred.
- Prior experience with MCG strongly preferred.
Responsibilities
- Assess services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
- Analyze clinical service requests from members or providers against evidence based clinical guidelines.
- Identify appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
- Conduct reviews to determine prior authorization/financial responsibility for Molina and its members.
- Process requests within required timelines.
- Refer appropriate cases to medical directors and present them in a consistent and efficient manner.
- Request additional information from members or providers as needed.
- Collaborate with multidisciplinary teams to promote the Molina care model.
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