Care Review Clinician, Inpatient Review (BH) LICSW, LMFT, LMHC Remote in WA:

Molina Healthcare; Bellevue (WA); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading healthcare provider is seeking a Care Review Clinician to assess and coordinate care for members with high needs. This remote position requires licensure and experience in behavioral health. Candidates must work independently in a fast-paced environment while adhering to compliance standards. Join a dedicated team focused on delivering quality care and improving patient outcomes.

Qualifications

• 3+ years Behavioral Health hospital acute care/medical experience.
• Active, unrestricted State license in good standing.

Responsibilities

• Assess inpatient services for members to ensure optimum outcomes.
• Conduct inpatient reviews to determine financial responsibility.
• Collaborate with multidisciplinary teams to promote care model.

Skills

Behavioral Health

Clinical Assessment

Collaboration

Education

Master's Degree in Social Work

Master's Degree in Psychology

Job description

Care Review Clinician, Inpatient Review (BH) LICSW, LMFT, LMHC Remote in WA:

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Care Review Clinician, Inpatient Review (BH) LICSW, LMFT, LMHC Remote in WA:

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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.

Job Description

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.

This position will be supporting our Washington State Plan. We are seeking a candidate with a LICSW, LMFT, LMHC or LPCC licensure with previous UM and managed care experience. Proficient technology experience is highly preferred. Must be able to work independently in a high-volume environment. Further details to be discussed during our interview process.

Remote position; The CRC must be able to work PST hours

Work hours: Monday-Friday: 8:00AM - 5:00PM PST with coverage of at least one holiday a year for 4 hours.

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: $26.41 - $46.81 / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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