Care Review Clinician (RN) Remote (Must Work PST)

reputed company reputed company This RN will support Utilization Review for our NV reputed company members. Excellent computer skills and attention to detail are reputed company important to multitask between systems, talk with providers on the phone, and reputed company accurate contact notes. This is a telephonic position and productivity is important. Preferred candidates will have previous utilization management, managed care, or inpatient hospital experience. Experience in a behavioral health setting would be a plus. Schedule: Monday through Friday 8:00AM to 5:00PM PST (Weekends and holidays as needed). 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 them 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 experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered reputed company (RN). Nevada 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. Preferred Qualifications • Recent hospital experience in discharge planning. 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 Apply tot his job Apply To this Job