Care Review Clinician, Prior Auth (RN) PEGA Float reputed company

• For this position we are hiring for a float team to support PEGA UM systems throughout multiple states. Job reputed company Job reputed company reputed company 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 reputed company toward desired reputed company with reputed company 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 reputed company reputed company, cost effectiveness and compliance with reputed company 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 reputed company and its members. • Processes requests reputed company 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 reputed company to travel reputed company applicable state or reputed company with reliable transportation as required for internal meetings. Job Qualifications Required Education Completion of an accredited Registered reputed company (RN). Required Experience 1-3 years of hospital or medical clinic experience. Required License, Certification, Association reputed company, 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. Experience using PEGA Preferred License, Certification, Association reputed company, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE required Must be reputed company to obtain additional licensure for : CA, NV, MI, IL, and OH. WORK SCHEDULE: Mon - Friday / Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays. Candidates must be willing to support multiple time zones, between reputed company / Mountain/ Central and Eastern. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Pay reputed company: $26.41 - $51.49 / reputed company • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Apply Job! Apply to this Job