Care Review Clinician, Inpatient Review (RN)

Molina Healthcare; Austin (TX); On-site; USD 80,000 - 100,000; Full time

Job summary

Molina Healthcare is seeking an experienced Care Review Clinician to join their inpatient review team in Austin, Texas. This role requires a dedicated RN with strong analytical abilities and multi-tasking skills to ensure optimum patient outcomes by assessing inpatient services against clinical guidelines. A competitive salary and full-time employment are offered, with potential growth within the organization.

Qualifications

• Active, unrestricted State Registered Nursing (RN) license in good standing.
• 3+ years of hospital acute care experience.
• Recent hospital experience in ICU, Medical, or ER unit preferred.

Responsibilities

• Conduct initial and concurrent reviews for inpatient services.
• Analyze clinical service requests against evidence-based guidelines.
• Collaborate with multidisciplinary teams to promote effective care.

Skills

Multi-tasking

Analytical skills

Computer skills

Education

Graduate from an Accredited School of Nursing

Bachelor's Degree in Nursing

Tools

Microsoft Office Suite

Job description

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Job Description

Opportunity for experienced Utilization Review RN in the state of Texas. You will be hired to join the inpatient review team doing initial and concurrent reviews. Preference will be given to those whose UM experience is within another MCO like Molina; experience with Interqual/MCG guidelines is needed. Excellent computer, multi-tasking skills, and analytical thought processes are vital to be successful in this role. Productivity is important with specific turnaround times that must be met.

Job Description

Opportunity for experienced Utilization Review RN in the state of Texas. You will be hired to join the inpatient review team doing initial and concurrent reviews. Preference will be given to those whose UM experience is within another MCO like Molina; experience with Interqual/MCG guidelines is needed. Excellent computer, multi-tasking skills, and analytical thought processes are vital to be successful in this role. Productivity is important with specific turnaround times that must be met.

To start, hours are Monday – Friday, 8 AM – 5 PM CST; there is also weekend rotation required and some holiday coverage as well.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note.

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

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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 - $51.49 / HOURLY

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

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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