Talent.com
No longer accepting applications
Care Review Clinician LPN / LVN

Care Review Clinician LPN / LVN

Molina HealthcareCincinnati, OH, United States
11 days ago
Job type
  • Full-time
Job description

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

  • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all 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 within required timelines.
  • Refers appropriate cases to medical directors (MDs) and presents cases 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 health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
  • Clinical licensure and / or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
  • Ability to prioritize and manage multiple deadlines.
  • Excellent organizational, problem-solving and critical-thinking skills.
  • Strong written and verbal communication skills.
  • Microsoft Office suite / applicable software program(s) proficiency.
  • LPN / LVN licensure required

    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).

    MULTI STATE / COMPACT LICENSURE

    Individual state licensures which are not part of the compact states are required for : CA, NV, IL, and MI

    WORK SCHEDULE : 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 : $24 - $56.17 / HOURLY

  • Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
  • Create a job alert for this search

    Lpn Lvn • Cincinnati, OH, United States

    Related jobs
    • Promoted
    LPN / LVN - Correctional

    LPN / LVN - Correctional

    American Medical StaffingLebanon, OH, US
    Full-time
    American Medical Staffing is seeking a LPN / LVN Correctional for a local contract job in Lebanon, Ohio.Job Description & Requirements. We’re living in the new normal.Lives and careers loo...Show moreLast updated: 30+ days ago
    Travel LPN / LVN - $1,131 to $1,254 per week in Springfield, OH

    Travel LPN / LVN - $1,131 to $1,254 per week in Springfield, OH

    TravelNurseSourceCincinnati, Ohio, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified Other LPN / LVN in Springfield, Ohio, 45505!.Ready to start your next travel adventure? LRS Healthcare offers a full benefits pa...Show moreLast updated: 27 days ago
    RN / LPN - Nurse Health Screener - Cincinnati, OH

    RN / LPN - Nurse Health Screener - Cincinnati, OH

    Quest DiagnosticsCincinnati, Ohio, United States
    Part-time
    Quick Apply
    This position offers supplemental income as an Independent Contractor.During a biometric wellness screening, a provider will collect a number of measurements, including height, weight, blood pressu...Show moreLast updated: 30+ days ago
    • Promoted
    MDS Nurse (Registered Nurse or LPN) - Sign On Bonus

    MDS Nurse (Registered Nurse or LPN) - Sign On Bonus

    The Laurels of Milford CareersMilford, OH, United States
    Full-time
    Are you an experienced MDS nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at The Laurels of Milford may be just what you're looking for!.Laurel Hea...Show moreLast updated: 26 days ago
    • Promoted
    LPN / LVN - Correctional - $24 per hour - Urgently Hiring

    LPN / LVN - Correctional - $24 per hour - Urgently Hiring

    American Medical StaffingLebanon, OH, United States
    Full-time
    American Medical Staffing is seeking a LPN / LVN Correctional for a local contract job in Lebanon, Ohio.Job Description & Requirements. We’re living in the new normal.Lives and careers look differen...Show moreLast updated: 30+ days ago
    Remote - Licensed Practical Nurse - LPN - LVN - Intake Coordinator

    Remote - Licensed Practical Nurse - LPN - LVN - Intake Coordinator

    CareHarmonyCincinnati, OH, US
    Remote
    Full-time
    Quick Apply
    CareHarmony’s Intake Coordinators (LPN) (NLC) (LVN) work comprehensively with providers to deliver value-based care management initiatives for their patients. CareHarmony is seeking an experienced L...Show moreLast updated: 30+ days ago
    Travel LPN / LVN - $1,810 to $2,007 per week in Columbus, OH

    Travel LPN / LVN - $1,810 to $2,007 per week in Columbus, OH

    TravelNurseSourceCincinnati, Ohio, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified Other LPN / LVN in Columbus, Ohio, 43219!.Ready to start your next travel adventure? LRS Healthcare offers a full benefits packa...Show moreLast updated: 30+ days ago
    LPN Intake Coordinator- Cincinnati, OH

    LPN Intake Coordinator- Cincinnati, OH

    Interim HealthCareCincinnati, OH, US
    Full-time +1
    As an LPN Intake Coordinator you will provide a centralized intake and client service function in order to gather pertinent patient / client, clinical and financial information to optimize sales, cu...Show moreLast updated: 30+ days ago
    Unit Manager LPN or RN

    Unit Manager LPN or RN

    Confidence Management SystemsCincinnati, Ohio, US
    Full-time
    Quick Apply
    Ohio Oaks, located in Cincinnati, Ohio, is currently seeking a skilled professional.Skilled Long-Term Care facility.This position requires strong leadership skills, clinical expertise, and a passio...Show moreLast updated: 5 days ago
    • Promoted
    Weekend LVN Home Health Shift Care

    Weekend LVN Home Health Shift Care

    Encompass HealthOwenton, KY, Owen County, KY; Kentucky, United States
    Full-time +1
    LPN / LVN Career Opportunity - PRN Positions Available; Days and Nights Embark on Your Compassionate LPN / LVN Journey at Encompass Health Are you in search of a fulfilling healthcare career close to y...Show moreLast updated: 1 day ago
    Travel LPN / LVN - $1,120 to $1,241 per week in Springfield, OH

    Travel LPN / LVN - $1,120 to $1,241 per week in Springfield, OH

    TravelNurseSourceCincinnati, Ohio, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified Other LPN / LVN in Springfield, Ohio, 45505!.Ready to start your next travel adventure? LRS Healthcare offers a full benefits pa...Show moreLast updated: 11 days ago
    • Promoted
    LPN Intake Coordinator- Edgewood, KY

    LPN Intake Coordinator- Edgewood, KY

    Interim HealthCareElsmere, KY, US
    Temporary
    Description On-site in Edgewood, KY LPN required.As an LPN Intake Coordinator you will provide a centralized intake and client service function in order to gather pertinent patient / client, clinical...Show moreLast updated: 1 day ago
    • Promoted
    Addiction Nurse - LPN

    Addiction Nurse - LPN

    Brightview HealthIndependence, KY, US
    Full-time
    Are you a dedicated and experienced Licensed Practical Nurse with a passion for assisting individuals on their journey towards mental health and recovery? We're seeking a proactive and compassi...Show moreLast updated: 1 day ago
    • Promoted
    Travel LPN / LVN - Psychiatric - $905 per week - Urgently Hiring

    Travel LPN / LVN - Psychiatric - $905 per week - Urgently Hiring

    Supplemental Health CareLebanon, OH, United States
    Full-time +1
    Supplemental Health Care is seeking a LPN / LVN Psychiatric for a travel job in Lebanon, Ohio.Job Description & Requirements. Supplemental Health Care is a national hiring partner for facilities acr...Show moreLast updated: 28 days ago
    Travel LPN / LVN - $1,272 to $1,410 per week in Springfield, OH

    Travel LPN / LVN - $1,272 to $1,410 per week in Springfield, OH

    TravelNurseSourceCincinnati, Ohio, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified Other LPN / LVN in Springfield, Ohio, 45505!.Ready to start your next travel adventure? LRS Healthcare offers a full benefits pa...Show moreLast updated: 6 days ago
    • Promoted
    • New!
    LPN

    LPN

    Baptist Convalescent Center, Inc.Erlanger, KY, US
    Full-time
    In using the ministry of Jesus Christ as our model, we seek to provide quality of life options to assist adults 55+ to remain active by maintaining a healthy lifestyle.Make Someone’s Life Bet...Show moreLast updated: 22 hours ago
    • Promoted
    LPN Licensed Practical Nurse - (Day Shift) (Monroe)

    LPN Licensed Practical Nurse - (Day Shift) (Monroe)

    Ohio Living Mount PleasantMonroe, Ohio, US
    Full-time
    It's fun to work in a company where people truly BELIEVE in what they're doing!.Sustained members of our team demonstrate accountable behavior and share our values of customer service, innovation, ...Show moreLast updated: 5 days ago
    • Promoted
    Licensed Practical Nurse (LPN)

    Licensed Practical Nurse (LPN)

    The Laurels of MilfordMilford, OH, US
    Full-time
    New increased wage scale for LPNS! .Memory care unit LPN 3rd shift.Do you work for Agency? Are you Tired of inconsistent schedules and last-minute Cancellations? Come Join our Team at the Laurels o...Show moreLast updated: 30+ days ago
    • Promoted
    MDS Nurse (Registered Nurse or LPN)

    MDS Nurse (Registered Nurse or LPN)

    The Laurels of MilfordMilford, Ohio, US
    Full-time
    Sign on bonus available! Are you an experienced MDS nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at The Laurels of Milford may be just what you'r...Show moreLast updated: 27 days ago
    RN / LPN / Therapist

    RN / LPN / Therapist

    Medacare Transportation Inc.Cincinnati, Ohio, United States
    Full-time
    Quick Apply
    Now hiring RNs, LPNs, and therapists for Home Health patients!.PRN, Full-Time, Part-Time…flexibility, and mileage reimbursement!. Butler, Clermont, Hamilton, and Warren counties.Following the plan o...Show moreLast updated: 30+ days ago