What are the responsibilities and job description for the Care Review Clinician, PA (RN) - LTSS position at Molina Healthcare Group?
Job Description
JOB DESCRIPTION
For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they reside in. Strong medical and hospital analytical experience is needed. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Strong computer skills, being able to toggle back and forth and use multiple databases. Good analytical thought process is important to be successful in this role, this is a metric-based environment. This role will support VA Medicaid LTSS population. Prefer candidates that have experience doing prior authorizations for LTSS services preferrable with Medicaid Insurance. - Preferred location state of VA
WORK SCHEDULE: Monday thru Friday 8:00AM to 5:00PM EST
This is a Remote position, home office with internet connectivity of high speed required.
VA Preferred location, will consider any applicant within the United States
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 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 Molina Healthcare 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.
- Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Registered Nurse (RN).
Required Experience
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
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.
Job Info
Job Identification: 2027334
Job Category: Clinical
Posting Date: 2024-08-05T17:35:56 00:00
Job Schedule: Full time
