Title: Care Review Clinician
Company: TotalMed Staffing
Hours: Part-time - 20hrs/week
Contract length: 1 year
Remote position: Candidate can be located anywhere in US, however, MUST HAVE ACTIVE WASHINGTON STATE LICENSE to qualify for the position.
Required License, Certification, Association: Active, unrestricted WA licensure. Can be one of the following licensures.
- LPN with BH experience
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for the Members to ensure optimum outcomes, cost-effectiveness and compliance with all state and federal regulations and guidelines. Essential Functions: Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care. Maintains department productivity and quality measures. Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with the provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to the company Code of Conduct. Consults with and refers cases to Molina medical directors regularly, as necessary. Complies with required workplace safety standards.
Demonstrated ability to communicate, problem-solve, and work effectively with people. Excellent organizational skills with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously. Knowledge of applicable state, and federal regulations. In-depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA. Ability to take initiative and see tasks to completion. Computer Literate (Microsoft Office Products). Excellent verbal and written communication skills. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
Job Types: Part-time, Contract
Pay: $35.00 - $40.00 per hour
- Utilization Management: 2 years (Preferred)
- Behavioral Health: 3 years (Preferred)
- Do you have an ACTIVE WASHINGTON STATE LICENSE? (RN, LVN/LPN, LCSW, LPCC, LMFT)
Hours per week: