Care Review Clinician, Inpatient Review (RN) Remote based in Arizona

Lensa; Phoenix (AZ); Remote; USD 80,000 - 100,000; Full time

Job summary

An innovative healthcare organization is seeking a Care Review Clinician to enhance patient outcomes through effective utilization management. This remote role requires an Arizona RN license and offers the opportunity to work with multidisciplinary teams, ensuring high-quality care for patients. The ideal candidate will have a strong background in inpatient review and behavioral health, with a commitment to compliance and cost-effectiveness. Join a forward-thinking company that values your expertise and offers competitive compensation and benefits, making a significant impact in the healthcare field.

Qualifications

• 3+ years of hospital acute care/medical experience required.
• Active RN license in good standing is mandatory.

Responsibilities

• Assess inpatient services for optimal outcomes and compliance.
• Collaborate with multidisciplinary teams to promote care model.

Skills

Utilization Management

Clinical Analysis

Inpatient Review

Behavioral Health Knowledge

Education

Graduate from an Accredited School of Nursing

Bachelor's Degree in Nursing

Tools

MCG Guidelines

InterQual Guidelines

Job description

Care Review Clinician, Inpatient Review (RN) Remote based in Arizona

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Care Review Clinician, Inpatient Review (RN) Remote based in Arizona

Job Summary: Molina Healthcare Services (HCS) collaborates with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate integrated care across the continuum, including behavioral health and long-term care, for members with high potential needs. HCS staff work to ensure patients achieve desired outcomes with quality, medically appropriate, and cost-effective care based on illness severity and service site.

This position supports the Arizona state Plan. Candidates must have an Arizona RN license. Experience with Utilization Management (UM) and prior authorization for inpatient and outpatient services is required. Behavioral Health background is highly preferred. Details will be discussed during the interview.

Location and Work Hours: Remote position, must reside in Arizona. Work hours are Monday - Friday, 8:30 am - 5:00 pm Mountain Time, with some weekends and holidays.

Knowledge, Skills, and Abilities:

• Assess inpatient services to ensure optimal outcomes, cost-effectiveness, and compliance with regulations.
• Analyze clinical service requests against evidence-based guidelines.
• Identify appropriate benefits, eligibility, and expected length of stay.
• Conduct inpatient reviews to determine financial responsibility; perform prior authorization reviews as needed.
• Process requests within required timelines.
• Refer cases to Medical Directors and present them efficiently.
• Request additional information from members or providers.
• Make referrals to other clinical programs.
• Collaborate with multidisciplinary teams to promote Molina Care Model.
• Adhere to UM policies and procedures.
• Occasional travel to other Molina offices or hospitals may be required, depending on the 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, and Association:

Active, unrestricted State Registered Nursing (RN) license in good standing. Valid driver’s license with good driving record and reliable transportation. Licensed within the appropriate state.

Preferred Education:

Bachelor's Degree in Nursing.

Preferred Experience:

Recent hospital experience in ICU, Medical, or ER units. Experience with MCG and/or InterQual guidelines. Behavioral Health and Physical Health Utilization Management reviews.

Preferred License, Certification, and Association:

Active, unrestricted Utilization Management Certification (CPHM).

Interested employees should apply through the intranet job listing. Molina Healthcare offers competitive benefits and compensation. Molina is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $26.41 - $51.49 per hour. Actual compensation may vary based on location, experience, education, and skills.