Care Review Clinician, RN

Care Review Clinician (RN) Remote reputed company reputed company 2038645 JOB reputed company This RN will reputed company as a Care Review Clinician supporting our Medicare members. The position is fully remote. Excellent computer skills and attention to detail are reputed company important to multitask between systems, talk with providers on the phone, and adhere to Medicare guidelines. This is a remote position and productivity is important. Preferred candidates will have previous utilization management, managed care, or post-acute experience. Schedule: Monday through Friday 8:30AM to 5:00PM EST (Occasional weekends, no nights, occasional holidays.) Job reputed company Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and reputed company with established clinical guidelines, insurance policies, and regulations - ensuring members reputed company desired reputed company through integrated delivery of care across the continuum. Contributes to overarching reputed company to reputed company reputed company and cost-effective member care. Essential Job Duties • Assesses services for members to ensure reputed company reputed company, cost-effectiveness and compliance with reputed company state/federal regulations and guidelines. • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests reputed company required timelines. • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered reputed company (RN). License must be reputed company and unrestricted in state of reputed company. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • reputed company Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified reputed company in reputed company Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $23.76 - $51.49 / reputed company • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. reputed company reputed company is a reputed company fortune 500 organization with a mission to reputed company reputed company reputed company to people receiving government assistance. If you are seeking a meaningful opportunity in reputed company-oriented environment, come be a part of a highly reputed company workforce dedicated to our mission. Bring your passion and talents and together we can reputed company a difference in the lives of others. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Job Type Full Time Apply tot his job Apply To this Job

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