We are looking for a Care Review Clinician to join our growing team. You will be offered a competitive hourly rate of $42.02/ hour. We will also provide you a comprehensive benefits package.

As a Care Review Clinician you will work with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time

Responsibilities of the Care Review Clinician:

Reviewing clinical for medical necessity of physical/behavioral admissions, or procedures.
Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review
Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines
Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team
Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures
Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long Term Care
Maintains department productivity and quality measures
Completes assigned work plan objectives and projects on a timely basis
Maintains professional relationships with provider community and internal and external customers

Job Types: Full-time, Contract, Temporary

Pay: $42.02 per hour

Schedule:

8 hour shift

Experience:

Utilization management: 3 years (Required)
behavioral health or physical health: 2 years (Preferred)

License/Certification:

RN or LPN (Required)

Work Location: Remote

Workpath Partners

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Care Review Clinician