Care Review Clinician, PA
Company: Molina Healthcare
Location: Syracuse
Posted on: October 14, 2020
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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. 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. Qualifications 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. Preferred Education Completion of an accredited Registered Nurse (RN). Preferred Experience 1-3 years of hospital or medical clinic experience. Preferred 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.
Keywords: Molina Healthcare, Syracuse , Care Review Clinician, PA, Other , Syracuse, New York
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