Care Review Clinician, Inpatient Review (BH)

Molina Healthcare; Louisville (KY); Remote; USD 10,000 - 60,000; Full time

Job summary

Molina Healthcare is seeking a Care Review Clinician to provide prior authorization for outpatient and inpatient services for the OH Medicaid behavioral health population. The ideal candidate will have a Master's degree in a related field and experience in behavioral health, ensuring quality care and regulatory compliance.

Benefits

Competitive benefits and compensation package

Qualifications

• 3+ years of Behavioral Health hospital acute care/medical experience.
• Active and unrestricted State license in good standing such as LCSW, LPCC, or LMFT.

Responsibilities

• Provide prior authorization for outpatient and inpatient services.
• Analyze clinical service requests against evidence-based clinical guidelines.
• Conduct inpatient reviews for financial responsibility.

Skills

Analytical skills

Computer multi-tasking

Education

Master's Degree in Social Work or related field

Job description

JOB DESCRIPTION

For this position we are seeking a Licensed Masters Level social worker, counselor, therapist and/or RN with a current active license for state of KY or RN who must be licensed in KY or have a compact RN license.

The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and inpatient services for the OH Medicaid behavioral health population. Strong post-acute level of care experience (Nursing Facilities, Acute Inpatient, Rehabilitation, Long Term Acute care hospital, Behavioral Health Facility. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good analytical thought process is important to be successful in this role. Prefer candidates that have experience doing prior authorizations for outpatient services preferrable within Behavioral Health Population.

WORK SCHEDULE: Monday thru Friday 8:00 AM to 5:00 PM EST - Training Schedule (30 to 60 days)

Permanent schedule will require you to work 4 to 5 days a week - with one weekend day required (Saturday, Sunday (either one or both))

This is a Remote position, home office with internet connectivity of high speed required.

Job Summary

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.

KNOWLEDGE/SKILLS/ABILITIES

• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and 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 inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.
• Processes requests within required timelines.
• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
• 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.

JOB QUALIFICATIONS

Required Education

Master's Degree in Social Work, Psychology, or other Behavioral Health field

Required Experience

3+ years Behavioral Health hospital acute care/medical experience.

Required License, Certification, Association

• Active, unrestricted State license in good standing, such as LCSW, LPCC or LMFT.
• Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements:

IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment. Master’s Degree in Social Work, Psychology, or other Behavioral Health field, or graduate from an accredited School of Nursing. Active, unrestricted State license in good standing, such as LCSW, LPCC, LMFT or RN.

Preferred Education

Master's Degree in Clinical Social Work

Preferred Experience

Recent Behavioral Health hospital experience in ICU, Medical, or ER unit.

Preferred License, Certification, Association

Active and unrestricted Licensed Clinical Social Worker

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

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $25.08 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.