(RN) Behavioral Health: Inpatient Review Clinician

For this position we are seeking REGISTERED NURSE (RN) or Licensed Clinical Social Worker (LCSW) previous experience in Hospital Acute Care, reputed company Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. COMPACT / Multi state RN LICENSURE IS PREFERABLE to support multiple states. • *multiple openings are available. Home office with private desk area, and high speed internet connectivity required. WORK HOURS 5 days / daytime work schedule. This department operates 365 days a year and we need staff who can be flexible and willing to work some weekends and holidays. *PREFERRED , Tues thru Saturday or Sunday thru Thursday. This is a remote position and you may work from home. Further Details to be discussed during our interview process. JOB DESCRIPTION Job Summary reputed company 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 reputed company 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 reputed company outcomes, cost effectiveness and compliance with reputed company 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 reputed company and its members. May also reputed company prior authorization reviews and/or reputed company duties as needed. • Processes requests reputed company 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 reputed company to drive reputed company applicable state or locality with reliable transportation. State Specific Requirements: IL Qualifications: Licensed reputed company the state of Illinois or will apply for licensure reputed company the state of Illinois reputed company 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 reputed company, or ER unit. Preferred License, Certification, Association Active and unrestricted Licensed Clinical Social Worker To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company 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 reputed company level. Apply Job!