RN Care Review Clinician, Inpatient Review (BH) Marketplace
: Job Details :

**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 inpatient 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, eligibility and expected length of stay for requested treatments and/or procedures.+ Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.+ Processes requests within required timelines.+ Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.+ 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**Master's Degree in Social Work, Psychology, or other Behavioral Health field**Required Experience**3+ years Behavioral Health hospital acute care/medical experience.**Required License, Certification, Association**+ Active, unrestricted State license in good standing, such as LCSW, LPCC or LMFT.+ Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.**State Specific Requirements:**IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment. Master's Degree in Social Work, Psychology, or other Behavioral Health field, or graduate from an accredited School of Nursing. Active, unrestricted State license in good standing, such as LCSW, LPCC, LMFT or RN.**Preferred Education**Master's Degree in Clinical Social Work**Preferred Experience**Recent Behavioral Health hospital experience in ICU, Medical, or ER unit.Working experience with Interqual, MCG Guidelines, or ASAM guidelines.**Preferred License, Certification, Association**Active and unrestricted Licensed Clinical Social WorkerRegistered Nurse, Compact nursing licensure_WORK HOURS 5 days / daytime work schedule, some weekends and holidays. *PREFERRED , Tues thru Saturday or Sunday thru Thursday._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.