Care Review Clinician, Inpatient Review - Long Beach, United States - Molina Healthcare

Molina Healthcare

Verified Company

Long Beach, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

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 knowledge of Interqual / MCG guidelines.

CALIFORNIA LICENSURE IS REQUIRED FOR THIS ROLE IMMEDIATELY UPON HIRE. CALIFORNIA IS NOT A COMPACT STATE AT THIS TIME. Excellent computer multi tasking skills and analytical thought process is important to be successful in this role. Productivity is important with turnaround times.

Home office with private desk area, and high speed internet connectivity required.

Further details to be discussed during our interview process.

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

Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

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.

Under the direction of a Registered Nurse, identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

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.

JOB QUALIFICATIONS
Required Education

Graduate from an Accredited School of Nursing. Associate degree in Nursing preferred.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

Active, unrestricted State Licenses Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) license in good standing.

State Specific Requirements:

Preferred Experience

Recent hospital experience in Medical or ER unit.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range:
$21.6 - $46.81 / HOURLY