Care Review Clinician, Inpatient Review (RN)
Company: Molina Healthcare
Location: Olympia
Posted on: May 30, 2025
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Job Description:
JOB DESCRIPTION
Job SummaryMolina 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 EducationGraduate from an Accredited School of
Nursing.
Required Experience3+ years hospital acute care/medical
experience.
Required License, Certification, AssociationActive, 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.
Preferred Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth,
Utilization Review / Utilization Management and knowledge of
Interqual / MCG guidelines.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification
(CPHM).
MULTI STATE / COMPACT LICENSURE
WORK SCHEDULE: Mon - Fri / Sun - Thurs / Tues - Sat shift will
rotate with some weekends and holidays.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. Pay
Range: $26.41 - $61.79 / HOURLY *Actual compensation may vary from
posting based on geographic location, work experience, education
and/or skill level.
Keywords: Molina Healthcare, Kent , Care Review Clinician, Inpatient Review (RN), Healthcare , Olympia, Washington
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