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

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

Job summary

A leading healthcare provider is seeking a Care Review Clinician (RN) for a remote position in Arizona. The role involves assessing inpatient services and collaborating with teams to ensure quality care. Ideal candidates will have significant experience in acute care and a valid RN license. This full-time position offers competitive pay and benefits, with a focus on improving patient outcomes.

Qualifications

• 3+ years hospital acute care/medical experience.
• Active, unrestricted State Registered Nursing (RN) license.

Responsibilities

• Assess inpatient services for optimum outcomes and compliance.
• Conduct inpatient reviews to determine financial responsibility.
• Collaborate with multidisciplinary teams.

Skills

Assessment

Clinical Analysis

Collaboration

Compliance

Education

Graduate from an Accredited School of Nursing

Bachelor's Degree in Nursing

Job description

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

Be among the first 25 applicants. Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

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 support the Arizona state Plan. We are seeking a candidate with an Arizona RN licensure. The ideal candidate will have experience with UM and prior authorization with both inpatient and outpatient settings. Candidates with a Behavioral Health background are highly preferred. Further details will be discussed during the interview process.

Remote position, must reside in Arizona.

Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time with some weekends and holidays.

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 a 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, which may 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 a valid driver's license with a good driving record and reliable transportation. Must be licensed within the appropriate state.

Preferred Education

Bachelor's Degree in Nursing.

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

To all current Molina employees: If interested, 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 based on location, experience, education, and skill level.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: IT Services and IT Consulting

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