LPN Care Review Clinician, Prior Authorization Remote in WA state

Molina Healthcare; Long Beach (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

Molina Healthcare recherche un LPN/LVN pour évaluer et coordonner les soins des membres. Le candidat doit posséder des licences appropriées et 1-3 ans d'expérience en milieu clinique. Le poste est orienté vers la gestion des soins avec l'accent sur l'efficacité et la conformité réglementaire.

Benefits

Paquet de rémunération compétitif

Avantages sociaux complets

Qualifications

• Licences RN, LVN ou LPN requises.
• 1-3 ans d'expérience clinique ou hospitalière.
• Certifications en gestion des soins valorisées.

Responsibilities

• Assurer l'évaluation et l'autorisation des soins pour les membres.
• Analyser les demandes cliniques selon les directives pratiques.
• Collaborer avec d'autres équipes médicales.

Skills

Évaluation des services

Analyse des demandes

Collaboration en équipe

Gestion des autorisations

Education

Diplôme d'infirmier diplômé

Diplôme de soins de santé

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