Care Review Clinician LPN / LVN

Molina Healthcare; Salt Lake City (UT); On-site; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization in Salt Lake City is seeking a professional to provide support in clinical member services review. Responsibilities include assessing services for compliance, analyzing clinical requests, and collaborating with teams to ensure quality care. Candidates must have LPN/LVN licensure and 2 years of healthcare experience. This position offers competitive hourly pay and may involve shifts on weekends and holidays.

Benefits

Competitive benefits and compensation package

Flexible work schedule

Qualifications

• Experience in hospital acute care, inpatient review, or managed care.
• Clinical licensure needed if required by state regulations.
• Ability to prioritize and manage multiple deadlines.

Responsibilities

• Assess services for compliance and outcomes.
• Analyze clinical service requests against guidelines.
• Collaborate with multidisciplinary teams to promote care model.

Skills

Organizational skills

Problem-solving skills

Critical-thinking skills

Written communication

Verbal communication

Microsoft Office proficiency

Education

LPN / LVN licensure

2 years healthcare experience

Job description

Overview

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Responsibilities

• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/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 reviews to determine prior authorization/financial responsibility for Molina and its members.
• Processes requests within required timelines.
• Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner.
• Requests additional information from members or providers as needed.
• Makes appropriate referrals to other clinical programs.
• Collaborates with multidisciplinary teams to promote the Molina care model.
• Adheres to utilization management (UM) policies and procedures.

Qualifications

• At least 2 years health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills. Microsoft Office suite/applicable software program(s) proficiency.
• LPN / LVN licensure required

Preferred Experience

• Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.

Preferred License, Certification, Association

• Active, unrestricted Utilization Management Certification (CPHM).
• MULTI STATE / COMPACT LICENSURE – Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI

Work Schedule

Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays. Training will be held Mon - Fri.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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

Pay Range: $24 - $56.17 / HOURLY

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