Job Information
Molina Healthcare Sr Care Review Clinician, Prior Auth – TX licensed Physical Therapist ONLY in San Antonio, Texas
Job Description
Job Summary
Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals.
Knowledge/Skills/Abilities
• Identifies appropriate benefits, eligibility, and expected length of stay for requested treatments and/or procedures.
• Analyze clinical service requests from members or providers against evidence based clinical guidelines
• Process requests within required timelines
• Refer appropriate cases to Medical Directors and presents cases in a consistent and efficient manner
• Request additional information from members or providers
in consistent and efficient manner
• Appropriate referrals to other clinical programs
• Collaboration with multidisciplinary teams to promote Molina Care Model
• Adhere to UM policies and procedures
• Mentor New Care Review Clinicians during orientation period
•Sign off on core competencies for new Care Review Clinicians during peer mentoring phase
•Model New programs, techniques and trainings with peers.
Job Qualifications
Required Education
Completion of an accredited Licensed Vocational Nurse (LVN), or Licensed Rehabilitation Therapy (Occupational/Speech Therapy) or Licensed Practical Nurse (LPN) Program
Degree in area of Clinical Specialty
Required Experience
1-3 years clinical practice
Preferred Experience
3-5 years clinical practice with managed care experience
Preferred License, Certification, Association:
Active Registered Nursing license (RN), Licensed Clinical Social Worker LCSW, Licensed Marriage and Family Therapist LMFT, Utilization Management Certification (CPHM), Rehabilitation Therapy License (Occupational Therapist, Speech Therapist), Unrestricted Board Examiners
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: $23.76 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.