Care Review Clinician, Inpatient Review (BH)

Molina Healthcare • Louisville, KY

99d • $25 - $51

About The Position

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.

Requirements

• Master's Degree in Social Work, Psychology, or other Behavioral Health field.
• 3+ years Behavioral Health hospital acute care/medical experience.
• 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.
• Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment.

Nice To Haves

• Master's Degree in Clinical Social Work.
• Recent Behavioral Health hospital experience in ICU, Medical, or ER unit.
• Active and unrestricted Licensed Clinical Social Worker.

Responsibilities

• 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.

Benefits

• Competitive benefits and compensation package.

What This Job Offers

• Industry: Insurance Carriers and Related Activities
• Education Level: Master's degree