Detail of : Care Review Clinician, Prior Authorization Job Opening in Long Beach
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.
Assesses 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 and eligibility for requested treatments and/or procedures.
Conducts prior authorization reviews to determine financial responsibility for and its members.
Processes requests within required timelines.
Refers appropriate prior authorization requests to Medical Directors.
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.
Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a Bachelor's or Master's Degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only).
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing OR a clinical license in good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only).
Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
3-5 years clinical practice with managed care, hospital nursing or utilization management experience.
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.
offers a competitive benefits and compensation package. is an Equal Opportunity Employer (EOE) M/F/D/V.
If your qualification is matched with the requirement above, please submit your online application directly through Molina Healthcare system at :
Only qualified candidates that meet with the above requirements would be processed in this recruitment.
Only short listed candidates will be notified.
If you are not interested in Care Review Clinician, Prior Authorization Long Beach May 2021 Molina Healthcare above, you can try to find your job by read related jobs from another company in Long Beach below.
Apply This Job
Please submit your application via the link below:
Do not forget to like our fanpage to get the latest job information
Please note that we do not accept any CV submissions. If You want to apply for a job that you have discovered on jobs-chicago.net, simply click on the provided job application link and follow the instructions afterwards. You'll be taken to a more detailed page.