Care Review Clinician, PA (RN)

Job Description

JOB DESCRIPTION

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Job Summary

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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.

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KNOWLEDGE / SKILLS / ABILITIES

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• Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

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JOB QUALIFICATIONS

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Required Education

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Completion of an accredited Registered Nurse (RN).

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Required Experience

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1-3 years of hospital or medical clinic experience.

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Required License, Certification, Association

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Active, unrestricted State Registered Nursing (RN) license in good standing.

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Preferred Experience

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Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.

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Preferred License, Certification, Association

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Active, unrestricted Utilization Management Certification (CPHM).

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MULTI STATE / COMPACT LICENSURE

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

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WORK SCHEDULE : Sun - Thurs / Tues - Sat shift will rotate with some  holidays.

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Training will be held Mon - Fri

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To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.

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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