Prior authorization Jobs in Washington, DC
- New!
Care Review Clinician, Prior Auth (RN)
Molina HealthcareGEORGETOWN, US
Prior-Authorization Technician
The GW Medical Faculty AssociatesArlington, Virginia, Estados Unidos- Promoted
Prior Authorization Pharmacy Technician - DC licensed
MEDSTAR HEALTHWashington, DC, United States- New!
Prior-Authorization Technician- Pharmacy
MediabistroArlington, VA, United States
Assessment & Authorization Specialist
ST2 ManTech Advanced Systems IntlMclean, VA, USA
Launch Licensing & Authorization Director
StratolaunchWashington, District of Columbia, United States
System Authorization Support
SiloSmashersArlington, VA, USA
Senior Authorization Manager
International BaccalaureateDistrict of Columbia, United States
Prior Authorization Pharmacy Technician - DC licensed
MedStar Medical GroupWashington, DC, US
Coordinator of Prior Learning
University of the District of ColumbiaWashington, DC, US- New!
Prior-Authorization Technician- Pharmacy
MFA CoArlington, VA, United StatesCare Review Clinician, Prior Auth (RN)
Molina HealthcareGEORGETOWN, US- Full-time
JOB DESCRIPTION
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.
- Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Registered Nurse (RN).
Required Experience
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Preferred Experience
Previous experience in hospital Acute care, ER or ICU
Previous experience with InterQual or MCG guidelines
Work schedule : Mon - Fri daytime hours, some weekends and holidays required for all shifts.
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.
Pay Range : $26.41 - $61.79 / HOURLY