California resident preferred. Candidates who do not live in California must work Pacific daytime hours.
JOB DESCRIPTION
Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - 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.
Essential Job Duties
Required Qualifications
Preferred Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
CALIFORNIA State Specific Requirements :
Must be licensed currently for the state of California. California is not a compact state.
WORK SCHEDULE : Mon - Fri / Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.
Training will be held Mon - Fri
To all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V
Pay Range : $30.37 - $59.21 / HOURLY
Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
Clinician • Los Angeles, CA, United States