Care Review Clinician, PA (RN) Remote in New York

Lensa; City of Yonkers (NY); Remote; USD 80,000 - 100,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Care Review Clinician to join their remote team in New York. This role involves assessing and coordinating care for members, ensuring compliance with regulations, and collaborating with multidisciplinary teams. Ideal candidates will have a New York RN license and experience in prior authorization and managed care. This is a fantastic opportunity to make a significant impact on patient outcomes while enjoying a flexible work schedule. If you're passionate about delivering quality care in a dynamic environment, this position is perfect for you.

Qualifications

• New York RN licensure required.
• 1-3 years of hospital or medical clinic experience.

Responsibilities

• Assess services for members to ensure optimum outcomes.
• Conduct prior authorization reviews and collaborate with teams.

Skills

Prior Authorization

Clinical Assessment

Cost Effectiveness Analysis

Regulatory Compliance

Collaboration with Multidisciplinary Teams

Education

Registered Nurse (RN)

Job description

Care Review Clinician, PA (RN) Remote in New York

Care Review Clinician, PA (RN) Remote in New York

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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.

We are seeking a candidate with a New York RN licensure, UM and Prior Authorization experience. The Care Review Clinician must be able to work independently in a high-volume environment. Candidates with managed care organization (MCO) and NYS Medicaid guidelines experience are highly preferred. Further details to be discussed during our interview process.

Remote- requires NY RN license

Work schedule: Monday - Friday 8;30 am-5:00pm or 9:00am-530pm EST with rotating weekend and holiday-1 weekend every 5-6 weeks

Knowledge/Skills/Abilities

• Assesses 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 and eligibility for requested treatments and/or procedures.
• Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
• Processes requests within required timelines.
• Refers appropriate prior authorization requests to Medical Directors.
• 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.
• Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
  
  

Job Qualifications

Required Education

Completion of an accredited Registered Nurse (RN).

Required Experience

1-3 years of hospital or medical clinic experience.

Required License, Certification, Association

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

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 - $61.79 / HOURLY

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

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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