Talent.com
No longer accepting applications
Care Review Clinician, PA (RN)

Care Review Clinician, PA (RN)

Molina Healthcarebuffalo, ny, us
23 hours ago
Job type
  • Full-time
Job description

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, 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  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 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 - $51.49 / 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

    Care Review Clinician Pa Rn • buffalo, ny, us

    Related jobs
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $2,099 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $2,099 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with Atlas MedStaff to find a qualified ICU / Critical Care RN in Rochester, New York, 14621!. Atlas Medstaff is currently seeking candidates in the RN (ICU / CCU / Critical C...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Travel Registered Nurse - ICU / Critical Care - $430 per week in Rochester, NY

    Travel Registered Nurse - ICU / Critical Care - $430 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time +1
    TravelNurseSource is working with Nationwide Therapy Group to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. NTG is committed to matching you to the right position and we prid...Show moreLast updated: 3 hours ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $2,300 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $2,300 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with Advantis Medical Staffing to find a qualified ICU / Critical Care RN in Rochester, New York, 14445!. Advantis Medical, the #1 rated travel nurse agency, is currently ...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $1,866 to $2,069 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $1,866 to $2,069 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in Rochester, New York, 14621!. Ready to start your next travel adventure? LRS Healthcare offers a full bene...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $1,863 to $2,065 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $1,863 to $2,065 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in Rochester, New York, 14621!. Ready to start your next travel adventure? LRS Healthcare offers a full bene...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $2,146 to $2,379 per week in White Plains, NY

    Travel Nurse RN - ICU / Critical Care - $2,146 to $2,379 per week in White Plains, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in White Plains, New York, 10601!. Ready to start your next travel adventure? LRS Healthcare offers a full b...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $1,977 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $1,977 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with OneStaff Medical to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. An independently-owned, nationally-recognized and amazingly awesome staffi...Show moreLast updated: 14 days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $446 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $446 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time +1
    TravelNurseSource is working with Nationwide Therapy Group to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. NTG is committed to matching you to the right position and we prid...Show moreLast updated: 14 days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $2,124 to $2,355 per week in New York, NY

    Travel Nurse RN - ICU / Critical Care - $2,124 to $2,355 per week in New York, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in New York, New York, 10065!. Ready to start your next travel adventure? LRS Healthcare offers a full benef...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $422 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $422 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time +1
    TravelNurseSource is working with Nationwide Therapy Group to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. NTG is committed to matching you to the right position and we prid...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $2,355 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $2,355 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with Gifted Healthcare to find a qualified ICU / Critical Care RN in Rochester, New York, 14445!. The Gifted Healthcare Experience .Gifted Healthcare is an award-winning t...Show moreLast updated: 16 days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $1,946 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $1,946 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with OneStaff Medical to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. An independently-owned, nationally-recognized and amazingly awesome staffi...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $1,938 to $2,149 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $1,938 to $2,149 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. Ready to start your next travel adventure? LRS Healthcare offers a full bene...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Travel Nurse RN - ICU / Critical Care - $430 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $430 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time +1
    TravelNurseSource is working with Nationwide Therapy Group to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. NTG is committed to matching you to the right position and we prid...Show moreLast updated: 3 hours ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $1,931 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $1,931 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with OneStaff Medical to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. An independently-owned, nationally-recognized and amazingly awesome staffi...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $2,112 to $2,312 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $2,112 to $2,312 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with Ventura MedStaff to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. Are you ready to take your Travel career to the next level? See places yo...Show moreLast updated: 13 days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $2,425 per week in Buffalo, NY

    Travel Nurse RN - ICU / Critical Care - $2,425 per week in Buffalo, NY

    TravelNurseSourceBuffalo, NY, US
    Full-time +1
    TravelNurseSource is working with Prolink to find a qualified ICU / Critical Care RN in Buffalo, New York, 14201!.Prolink is a premier workforce solutions organization, fulfilling comprehensive staff...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $4,394 to $4,872 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $4,394 to $4,872 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. Ready to start your next travel adventure? LRS Healthcare offers a full bene...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ICU / Critical Care - $2,340 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $2,340 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with Gifted Healthcare to find a qualified ICU / Critical Care RN in Rochester, New York, 14445!. The Gifted Healthcare Experience .Gifted Healthcare is an award-winning t...Show moreLast updated: 2 days ago
    • Promoted
    • New!
    Travel Nurse RN - ICU / Critical Care - $3,200 per week in Rochester, NY

    Travel Nurse RN - ICU / Critical Care - $3,200 per week in Rochester, NY

    TravelNurseSourceBuffalo, New York, US
    Full-time
    TravelNurseSource is working with Coast Medical Service to find a qualified ICU / Critical Care RN in Rochester, New York, 14642!. Coast Medical Service is a nationwide travel nursing & allied hea...Show moreLast updated: 3 hours ago