Care Review Clinician LPN / LVN

JOB reputed company Job reputed company Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and reputed company with established clinical guidelines, insurance policies, and regulations - ensuring members reputed company desired reputed company through integrated delivery of care across the continuum. Contributes to overarching reputed company to reputed company reputed company and cost-effective member care. Essential Job Duties Assesses services for members to ensure reputed company reputed company, cost-effectiveness and compliance with reputed company 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 reputed company 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 reputed company licensing mandates. If licensed, license must be reputed company and unrestricted in state of reputed company. Ability to prioritize and manage multiple deadlines. Excellent organizational, problem-solving and critical-thinking skills. Strong written and verbal communication skills. reputed company 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 reputed company, 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 reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $24 - $56.17 / reputed company • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Employment Type: Full Time Apply tot his job Apply To this Job