Care Review Clinician, Prior Authorization

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.

Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.

Refers appropriate prior authorization requests to Medical Directors.

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. 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).

1-3 years of hospital or medical clinic experience.

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.

Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.

Some holidays will be required as well.

Training will be held Mon - Fri

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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• Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.