REMOTE RN CARE REVIEW CLINICIAN INPATIENT REVIEW – CA

Molina Healthcare
United States; United States
Job ID 2022657

JOB DESCRIPTION

WORK SCHEDULE: 

PERMANENT SHIFT WILL BE  A 12 hour NIGHT SHIFT  PACIFIC HOURS  7:30PM (in the evening) to 8:30AM (in the morning), 3 days a week will rotate. This department runs 24 / 7 / 365 days a year. Rotating weekends and holidays will be required. Please consider this requirement before applying to this position. 

TRAINING SCHEDULE WILL BE  Monday thru Friday  8:30AM to 5:30PM PACIFIC throughout a 2 – 3 month training and then will move to a 3 day/12 hour shift from then on.

Please consider these parameters before applying to this role. 

Excellent computer multi-tasking skills and analytical thought process is important to be successful in this role. Productivity is important with turnaround times.   Phone queue of 12 hours, experience with Utilization Management MCG/Milliman is very essential to this role. Retro review, assist with continued stays and discharges. 

This is a remote role (work from home), so candidates can live anywhere if they have a valid CALIFORNIA RN license and willing to get more licenses.  MUST WORK PACIFIC TIME ZONE HOURS AS POSTED. 

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
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 able to drive within applicable state or locality with reliable transportation.

State Specific Requirements:

CA Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment
Preferred Education
Bachelor’s Degree in Nursing
Preferred Experience
Recent hospital experience in ICU, Medical, or ER unit.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).

Pay Range: $54,922 – $107,099 annually

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.*

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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About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full TimePosting Date: 09/25/2023