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.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• 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.
• Under the direction of an Registered Nurse, identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
• 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.
Graduate from an Accredited School of Nursing. Associate's Degree in Nursing preferred.
3+ years hospital acute care/medical experience.
Required License, Certification, Association
Active, unrestricted State Licenses Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) license in good standing.
Recent hospital experience in Medical or ER unit.
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.
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