Care Review Clinician I - Molina Healthcare - Columbus, OH

– ( 166444 ) Remote : No Primary Location : US-OH-Columbus-OHCORPX Job : Healthcare Services Organization : Health Plans Job Type : Full-time Job Posting : Jul 26, 2016, 1:00:14 PM Knowledge/Skills/Abilities Provides prior authorizations according to Molina policy. Identifies appropriate benefits, eligibility, and expected length of stay (as appropriate) for members requesting new treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care. Maintains department productivity and quality measures. Attends regular staff meetings. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to Molina medical directors regularly, as necessary. Complies with required workplace safety standards. Works with the Utilization Management team and is primarily responsible for prior authorizations. According to guidelines provides inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.• Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skills with the ability to manage multiple priorities. Work collaboratively and handle multiple projects simultaneously. Knowledge of applicable state, and federal regulations. Knowledge of InterQual and other references for medical necessity determinations. Knowledge of NCQA requirements for prior authorization. Ability to take initiative and see tasks to completion. Computer Literate (Microsoft Office Products). Excellent verbal and written communication skills. Ability to abide by Molina’s policies. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers. Job Qualifications Required Education Completion of an accredited Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN) Program, or Bachelor’s degree in Social Work (a combination of experience and education will be considered in lieu of degree). Required Experience At least one year of clinical practice. Required License, Certification, Association Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing. No license requirement for BSW. Preferred Education Associates in Arts Degree Preferred Experience Managed Care Utilization Management Hospital utilization management Preferred License, Certification, Association Utilization Management Certification (CPHM) or other healthcare certification. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Also, fill out an Employee Transfer Notice Form (ETN) and attach it to your profile when applying online. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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Navigating the murky waters of federal health care plans is no easy feat, but Molina Healthcare’s mission is to help Medicaid and Medicare…

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