- Assesses 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.
-
Care Review Clinician, Inpatient Review
2 weeks ago
Molina Healthcare Long Beach, United States Full timeJOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE · For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. CAL ...
-
Care Review Clinician, Inpatient Review
4 weeks ago
Molina Healthcare Long Beach, United StatesJob DescriptionJOB DESCRIPTIONCare Review Clinician, Inpatient Review- Behavioral HealthFor this position we are seeking a LPC or LCSW who lives in and must be licensed for the state they reside. Strong inpatient medical and analytical experience is needed. Excellent computer mul ...
-
Care Review Clinician, Inpatient Review
1 day ago
Molina Healthcare Long Beach, United States**JOB DESCRIPTION** · Care Review Clinician, Inpatient Review- Behavioral Health · For this position we are seeking a LPC or LCSW who lives in and must be licensed for the state they reside. Strong inpatient medical and analytical experience is needed. Excellent computer multi-ta ...
-
Care Review Clinician, Inpatient Review
1 week ago
Molina Healthcare Long Beach, United States**JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE** · **For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines ...
-
Care Review Clinician, Inpatient Review
2 weeks ago
Molina Healthcare Long Beach, United StatesFor this position we are seeking a California (RN) Registered Nurse with 3 years+ Concurrent Review/ Utilization Review / Utilization Management and must have Interqual, and MCG guidelines experience. CURRENT RN CALIFORNIA LICENSURE IS REQUIRED FOR THIS POSITION. California is no ...
-
Care Review Clinician, Inpatient Review
2 weeks ago
Molina Healthcare Long Beach, United States**JOB TITLE**: CARE REVIEW CLINICIAN INPATIENT REVIEW : LICENSED VOCATIONAL NURSE, CALIFORNIA LICENSED · For this position we are seeking a (LVN) Licensed Vocational Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and k ...
-
Care Review Clinician, Inpatient Review
4 days ago
Molina Healthcare Long Beach, United States**JOB TITLE**: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE · For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. ...
-
Care Review Clinician, Inpatient Review
5 days ago
Molina Healthcare Long Beach, United States**DAY SHIFT 3-12 WORK SCHEDULE**: · TRAINING SCHEDULE WILL BE Monday thru Friday 8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift from then on. · Previous experience with Utilization Management / Utilization Review is very ess ...
-
Care Review Clinician, Inpatient Review
4 days ago
Molina Healthcare Long Beach, United StatesJob 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 ne ...
-
Care Review Clinician, Inpatient Review
3 weeks ago
Molina Healthcare Long Beach, United StatesJob 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 ne ...
-
Inpatient Review RN
1 week ago
Alignment Healthcare Orange, United States Full timeJob Number6669Workplace Type:Fully RemoteRemote - CA,California By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors From member e ...
-
Molina Healthcare Long Beach, United StatesJob 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 ne ...
-
Care Review Clinician, Inpatient Review
5 days ago
Molina Healthcare Los Angeles, United States**NIGHT SHIFT WORK SCHEDULE:** · **_PERMANENT SHIFT WILL BE A 12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS , 3 days a week will rotate. This department runs 24 / 7 / 365 days a year. Rotating weekends and holidays will be required._** **_C ...
-
Care Review Clinician I
2 weeks ago
Saviance Technologies Long Beach, United StatesWorks with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time. · Provides daily review and evaluat ...
-
Case Management
1 week ago
Blue Shield of California Long Beach, United States ProfessionalYour Role · The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you ...
-
Hospital Pharmacist Los Angeles, CA
2 weeks ago
Soliant Long Beach, United StatesMinimum 1+ years pharmacy experience required. · Soliant Health is excited to collaborate with a renowned 400-bed teaching hospital in Los Angeles to recruit an experienced Clinical Pharmacist for a 6-month contract. This opportunity offers a unique 7-on/7-off night shift schedul ...
-
Supv, Appeals
1 week ago
Molina Healthcare Long Beach, United StatesJob Description · JOB DESCRIPTION · Job Summary · Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider complaints and communicating resolution to provider and member ...
-
Clinical Services Coordinator, Intermediate
3 days ago
Blue Shield of California Long Beach, United States ProfessionalYour Role · The Children's Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. I ...
-
Physician (Chief of Imaging)
2 weeks ago
Veterans Health Administration Long Beach, United StatesSummary · The Long Beach VA Healthcare System is hiring one Physician for the Chief of Imaging position. The Imaging Healthcare Group (HCG) provides Radiology and Nuclear Medicine subspecialty services, inpatient, outpatient, and emergency services to Veterans and also oversees t ...
-
Hospital Pharmacist Los Angeles, CA
2 weeks ago
Soliant Long Beach, United StatesJob Description · Job DescriptionMinimum 1+ years pharmacy experience required. · Soliant Health is excited to collaborate with a renowned 400-bed teaching hospital in Los Angeles to recruit an experienced Clinical Pharmacist for a 6-month contract. This opportunity offers a uniq ...
Care Review Clinician, Inpatient Review - Long Beach, United States - Molina Healthcare
Description
_For this position we are seeking a California (RN) Registered Nurse with 3 years+ Concurrent Review/ Utilization Review / Utilization Management and must have Interqual, and MCG guidelines experience._
_CURRENT RN CALIFORNIA LICENSURE IS REQUIRED FOR THIS POSITION._
_California is not a compact state at this time._
_Excellent computer skills and attention to detail are very important to multi task between systems, talk with members on the phone, and enter accurate contact notes. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast paced position and productivity is important. Home office with private desk area, and high speed internet connectivity required._
_
WORK SCHEDULE:
5 days / daytime work schedule 8:30AM to 5:30PM PACIFIC with some weekends and holidays . Candidates who do not live in California must work Pacific Hours._
_This department operates 365 days a year and we need staff who can be flexible and willing to work some weekends to cover for weekend staff and holidays. This is a remote position and you may work from home._
_Further Details to be discussed during our interview process._
JOB DESCRIPTION
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
JOB QUALIFICATIONS
Required Education
Graduate from an Accredited School of Nursing.
Required Experience
3+ years hospital acute care/medical experience.
Required License, Certification, Association
Active, 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.
Preferred Education
Bachelor's Degree in Nursing
Preferred Experience
Recent hospital experience in ICU, Medical, or ER unit.
Preferred License, Certification, Association
Active, 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:
$ $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
