Care Review Clinician, Prior Authorization
MediabistroLas Cruces, Dona Ana County, NM, United States- Full-time
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.
Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
Refers appropriate prior authorization requests to Medical Directors.
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. Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a bachelor's or master's degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only).
1-3 years of hospital or medical clinic experience.
Active, unrestricted State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing OR a clinical license in good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only).
Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.
Some holidays will be required as well.
Training will be held Mon - Fri
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V
06 / 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 Prior Authorization • Las Cruces, Dona Ana County, NM, United States
- Promoted
Travel Nurse RN - ER / Trauma - $1,979 to $2,105 per week in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Travel Nurse RN - ER / Trauma - $2,365 to $2,466 per week in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Travel Nurse RN - ER / Trauma - $2,103 per week in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Travel Occupational Therapist (OT) - $2,246 per week in Rio Rancho, NM
AlliedTravelCareersLas Cruces, New Mexico, US- Promoted
OR TECH CERTIFIED
University of New Mexico - HospitalsSan Ysidro, NM, US- Promoted
Travel Nurse RN - ER / Trauma - $1,923 to $2,132 per week in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Travel Nurse RN - ER / Trauma - $2,060 per week in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Travel Nurse RN - ER / Trauma - $2,187 per week in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US
Clinical Manager - Emergency Room (RN)
BlackStarLas Cruces, New Mexico, United States- Promoted
Travel Nurse RN - OR - $2,166 to $2,401 per week in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Travel Nurse RN - OR - $2,648 per week in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Travel Nurse RN - ER / Trauma - $2,266 per week in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Travel Nurse RN - ER / Trauma - $1,704 to $1,968 per week in Silver City, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Travel Nurse RN - ER / Trauma - $1,504 to $1,736 per week in Roswell, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Clinical Manager (RN) - Emergency Room (ER)
Virtus Healthcare StaffingLas Cruces, NM, US- Promoted
Travel Nurse RN - Long-Term Care - $37 per hour in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Travel Registered Nurse - ER / Trauma - $1,979 to $2,105 per week in Rio Rancho, NM
TravelNurseSourceLas Cruces, New Mexico, US- Promoted
Clinical Manager (RN) - ER
Memorial Medical CenterLas Cruces, NM, US- Promoted
Clinical Manager (RN) – Emergency Room (ER)
Virtus Healthcare StaffingLas Cruces, NM, United States- Promoted
