LPN Care Review Clinician, Prior Authorization Remote in WA state

Molina Healthcare; Everett (WA); Remote; USD 60,000 - 80,000; Full time

Job summary

Molina Healthcare seeks a Licensed Practical Nurse (LPN) to join their team in Everett, WA. This role supports care coordination and ensures compliance with regulations while interacting with a multidisciplinary team to optimize patient outcomes. Candidates should possess an active WA state LPN license and have relevant clinical experience.

Benefits

Competitive benefits package

Equal Opportunity Employer

Qualifications

• Active, unrestricted WA state LPN license required.
• 1-3 years of clinical experience in medical settings.
• 3-5 years preferred experience with managed care.

Responsibilities

• Assess services for compliance and outcomes.
• Conduct prior authorization reviews.
• Collaborate with multidisciplinary teams.

Skills

Patient Assessment

Utilization Management

Clinical Analysis

Education

Completion of an accredited LPN Program

Job description

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 be supporting our Washington State Plan. We are seeking a candidate with a WA state LPN licensure.Candidates with case management, Utilization Management (UM), and direct managed care experience are highly preferred.Further details to be discussed during our interview process.

Work hours: Monday- Friday 8:00am- 5:00pm PST including rotational Sunday/Holiday coverage

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.

JOB QUALIFICATIONS

Required Education

Any of the following:

Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a bachelor’s or master’s degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only).

Required Experience

1-3 years of hospital or medical clinic experience.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing OR a clinical license in good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only).

Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.

Preferred Experience

3-5 years clinical practice with managed care, hospital nursing or utilization management experience.

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: $21.82 - $48.94 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.