Care Review Clinician, Prior Authorization Molina Healthcare 815 reviews

• Doral, FL 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. Job Qualifications Required Education Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a Bachelor's or Master's Degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). Required Experience 1-3 years of hospital or medical clinic experience. Required License, Certification, Association Active, unrestricted State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing OR a clinical license in good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only). Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings. Preferred Education n/a Preferred Experience 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. Preferred License, Certification, Association 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. 3 hours ago - save job - original job Apply On Company Site Other jobs you may like PG Authorization Clerk Jackson Health System - Miami, FL 7 days ago Pharmacy Authorization Spec Jackson Health System - Miami, FL 30+ days ago Authorization and Verification Specialist Hearing and Speech Center of Florida - Miami, FL 4 days ago Creative Writer / Author Genius Plaza - Miami, FL 30+ days ago Easily apply * Care Review Clinician jobs in Doral, FL * Jobs at Molina Healthcare in Doral, FL * Care Review Clinician salaries in Doral, FL Molina Healthcare Molina Healthcare 815 reviews Navigating the murky waters of federal health care plans is no easy feat, but Molina Healthcare's mission is to help Medicaid and Medicare... Let employers find you Thousands of employers search for candidates on Indeed Upload Your Resume