Care Review Clinician RN (BH Licensed) Nevada
Molina HealthcareHurricane, UT, USjob_description.job_card.1_day_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_descriptionNevada residents preferred. Candidates who do not live in Nevada must be willing to work Pacific Business Hours .\n\nJOB DESCRIPTION\n\nJob Summary\n\nProvides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations, and ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.\n\nEssential Job Duties\n\nAssesses services for members - ensuring optimum outcomes, cost-effectiveness and compliance with all state / federal regulations and guidelines.\nAnalyzes clinical service requests from members or providers against evidence based clinical guidelines.\nIdentifies appropriate benefits, eligibility and expected length of stay for requested treatments and / or procedures.\nConducts reviews to determine prior authorization / financial responsibility for Molina and its members.\nProcesses requests within required timelines.\nRefers appropriate cases to medical directors and presents cases in a consistent and efficient manner.\nRequests additional information from members or providers as needed.\nMakes appropriate referrals to other clinical programs.\nCollaborates with multidisciplinary teams to promote Molina care model.\nAdheres to utilization management (UM) policies and procedures.\nMay work collaboratively with appropriate departments to provide applied behavior analysis (ABA) / behavioral health therapy (BHT) services to Molina members with autism spectrum disorder (ASD) and other related disorders.\nMay approve requests for BHT by reviewing behavioral assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not limited to : psychological evaluation requests, comprehensive diagnostic evaluations, functional behavioral assessments, and progress reports.\nMay perform ongoing monitoring of BHT treatment plans to evaluate effectiveness and treatment efficacy.\nMay provide peer to peer consultation BHT in-network providers to support treatment planning and maximize member progress.\nMay work collaboratively with ABA providers to ensure best service practices for members.\nMay create and develops forms, recommendations and guidelines and training for BHT service delivery.\nMay collaborate and coordinate with behavioral health medical directors, and senior medical directors to ensure proper management of the BHT benefit.\n\nRequired Qualifications\n\nAt least 2 years health care experience, including experience in behavioral health and / or hospital acute care, or equivalent combination of relevant education and experience.\nLicensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT) or equivalent behavioral health licensure. License must be active and unrestricted in state of practice.\nMay require behavioral analyst experience, and / or board certification / licensure as a behavioral analyst (BCBA and / or LBA).\nDemonstrated knowledge of community resources.\nAbility to operate proactively and demonstrate detail-oriented work.\nAbility to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.\nAbility to work independently, with minimal supervision and demonstrate self-motivation.\nResponsive in all forms of communication, and ability to remain calm in high-pressure situations.\nAbility to develop and maintain professional relationships.\nExcellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.\nExcellent problem-solving, and critical-thinking skills.\nStrong verbal and written communication skills.\nMicrosoft Office suite / applicable software program(s) proficiency.\n\nPreferred Qualifications\nCertified Professional in Healthcare Management (CPHM).\nRecent hospital experience in an intensive care unit (ICU) or emergency room.\n\nASAM Certification for behavioral health\n\nPrevious experience with MCG guidelines.\n\nAt least 2 years of experience with inpatient concurrent review, prior authorization and managed care; Acute care hospital experience with discharge planning and critical thinking skill set.\n\nKnowledge with Nevada Medicaid State rules and regulations (Medicaid Service Manual, billing guidelines, Provider Types, fee schedules)\n\nAbility to handle change in fast paced environment\n\nTeam player with positive attitude for success\n\nPreferred License, Certification, Association\n\nActive, unrestricted Utilization Management Certification (CPHM).\n\nRN licensure preferred\n\nNevada State Specific Requirements : \n\nMust be licensed currently or obtain licensure w / in 30 days of hire, for the state of Nevada. Nevada is not a compact state.\n\nWORK SCHEDULE : Mon - Fri / Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.\n\nTraining will be held Mon - Fri\n\nTo all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board.\n\nMolina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V\n\nPay Range : $27.73 - $59.21 / HOURLY\n Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
serp_jobs.job_alerts.create_a_job
Licensed Clinician • Hurricane, UT, US
Job_description.internal_linking.related_jobs
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.
We guarantee 15-25 hours per week with an hourly pay of bet...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Malone Healthcare - Nursing is seeking a travel MRI Technologist for a travel job in St.Job Description & Requirements.About Malone Healthcare - Nursing.
With a commitment to providing a hi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.
We guarantee 15-25 hours per week with an hourly pay of bet...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.
We guarantee 15-25 hours per week with an hourly pay of bet...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 
LRS Healthcare - Allied is seeking a travel MRI Technologist for a travel job in St George, Utah.Job Description & Requirements.
LRS Healthcare - Allied Job ID #30I-27585.Pay package is based on...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
QuickMD is a leading telemedicine provider, delivering high-quality virtual care across 44 states.Since our founding in 2019, we have helped more than 100,000 patients access essential medical trea...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a variety o...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
RKA Recruiting is seeking a travel MRI Technologist for a travel job in St George, Utah.Job Description & Requirements.Dedicated and experienced healthcare staffing professionals that put our trave...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Licensed Psychiatric Nurse Practitioner.Wage : Between $89-$203 an hour.Did you know that you can build a flexible private practice on your terms as a psychiatric nurse practitioner?.Whether you wan...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Rocky Vista University in Ivins, UT as an opening for a.Adjunct Faculty Primary Care (Part-time).Close Date : there is no close date at this time for this position).
To be considered for this positio...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.
We guarantee 15-25 hours per week with an hourly pay of bet...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 
England is Now Hiring Dedicated CDL-A Team Drivers!.No-Touch Freight - Drivers Average $91,000 Annually per Driver •.Valid CDL-A and 3+ months of current experience required.This lane is not suitabl...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
We are seeking a skilled and reliable.The IV Tech will be responsible for initiating and monitoring intravenous therapy in accordance with state regulations and facility protocols.This is a PRN (as...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Remote Jobs are now available in your area.This position is a work from home position.You will not need to come into the office.
Benefits : Health Insurance, 401K, Vacation& PTO.Apply now! Work f...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
KPG Allied is seeking a travel MRI Technologist for a travel job in St George, Utah.Job Description & Requirements.Candidates must have at least 1 years of paid experience in the last 3 years.P...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 Rocky Vista University in Ivins, UT has an opening for an.Associate Director of Clinical Assessment & Simulation (Full-Time).
To be considered for this position applicants should submit a resume / cov...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.
We guarantee 15-25 hours per week with an hourly pay of bet...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 
Responsibilities The primary responsibility of this position is to read meters and record consumption of the water used, cleaning of meter boxes, and removal of vegetation impeding access to meters...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
- serp_jobs.job_card.promoted
Test Products from Home – $25-$45 / hr + Freebies
OCPAEnterprise city, Utah, usserp_jobs.job_card.part_time +1
- serp_jobs.job_card.promoted
Travel MRI Technologist
Malone Healthcare - NursingSaint George, UT, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Remote Product Tester – $45 / hr + Free Products – Start Now!
OCPAEnterprise city, Utah, usserp_jobs.filters.remote
serp_jobs.job_card.part_time +1
- serp_jobs.job_card.promoted
Flexible Remote Work – Get Paid to Share Your Opinions on Top Brands
OCPAEnterprise city, Utah, usserp_jobs.filters.remote
serp_jobs.job_card.part_time +1
- serp_jobs.job_card.promoted
Travel MRI Technologist
LRS Healthcare - AlliedSaint George, UT, USserp_jobs.job_card.permanent
- serp_jobs.job_card.promoted
Telemedicine Physician
QuickMDCedar City, UT, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Delivery Driver - Flexible Onboarding
DoorDashIvins, UT, United Statesserp_jobs.job_card.full_time +1
- serp_jobs.job_card.promoted
Travel MRI Technologist - $2,736 per week
RKA RecruitingSt George, UT, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Licensed Psychiatric NP
HeadwaySaint George, UT, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Adjunct Faculty Primary Care
InsideHigherEdIvins, Utah, United Statesserp_jobs.job_card.full_time +1
- serp_jobs.job_card.promoted
Hiring Now - Work from Home - No Experience
OCPAEnterprise city, Utah, usserp_jobs.filters.remote
serp_jobs.job_card.part_time +1
- serp_jobs.job_card.promoted
CDL-A Truck Drivers - Home Monthly - Average $91,000 / Yr - 3 Months Exp
C.R. EnglandEnterprise, UT, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Iv Tech Prn
Better Balance Psychiatry, PLLCSaint George, UT, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Work From Home
Remote JobsColorado City, AZserp_jobs.filters.remote
serp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Travel MRI Technologist
KPG AlliedSaint George, UT, USserp_jobs.job_card.permanent
- serp_jobs.job_card.promoted
Associate Director of Clinical Assessment & Simulation
InsideHigherEdIvins, Utah, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Work From Home Product Tester – $25-$45 / hr – No Experience Needed
OCPAEnterprise city, Utah, usserp_jobs.filters.remote
serp_jobs.job_card.part_time +1
- serp_jobs.job_card.promoted
County Meter Reader
Meter ReaderColorado City, AZserp_jobs.job_card.full_time