Care Review Clinician IP Review RN Critical Care Remote in WA state

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. We are seeking a candidate with a WA state RN licensure and critical care experience, i.e. ER or ICU. Candidates with Utilization Management and med/surge experience are highly preferred. Exceptional time management skills are needed to be successful in this position. Further details to be discussed during our interview process. Remote position preferably in Washington State. Work schedule: Tuesday- Saturday- 8:00am- 5:00pm PST with 1 hour lunch or 8:30-5:00 PST with 30-minute lunch. • 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 Graduate from an Accredited School of Nursing. Required Experience 3+ years hospital acute care/medical experience. Required License, Certification, Association Active, unrestricted State Registered Nursing (RN) license in good standing. 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 Preferred Education Bachelor's Degree in Nursing Preferred Experience Recent hospital experience in reputed company, or ER unit. Preferred License, Certification, Association Active, unrestricted Utilization Management Certification (CPHM). 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 - $59.21 / HOURLY • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Apply Job!