Introduction to Molina Healthcare Services
Molina Healthcare Services (HCS) is a leading healthcare organization dedicated to providing high-quality, patient-centered care to its members. Our team of skilled professionals works tirelessly 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. We are committed to ensuring that our patients receive medically appropriate and cost-effective care, regardless of the severity of their illness or the site of service.
Job Summary
We are seeking an experienced Behavioral Health Inpatient Review Clinician (RN or LCSW) to join our team in a fully remote capacity. As a key member of our utilization management team, you will be responsible for assessing inpatient services for our members, ensuring optimum outcomes, cost effectiveness, and compliance with all state and federal regulations and guidelines. Your strong clinical skills, knowledge of evidence-based clinical guidelines, and excellent communication skills will enable you to make a positive impact on the lives of our members.
Key Responsibilities
- Assess inpatient services for members to ensure optimum outcomes, cost effectiveness, and compliance with all state and federal regulations and guidelines
- Analyze clinical service requests from members or providers against evidence-based clinical guidelines
- Identify appropriate benefits, eligibility, and expected length of stay for requested treatments and/or procedures
- Conduct inpatient reviews to determine financial responsibility for Molina Healthcare and its members
- Process requests within required timelines and refer appropriate cases to Medical Directors
- Collaborate with multidisciplinary teams to promote the Molina Care Model and adhere to UM policies and procedures
- Make appropriate referrals to other clinical programs and request additional information from members or providers as needed
Essential Qualifications
To be successful in this role, you will need:
- A Master's Degree in Social Work, Psychology, or other Behavioral Health field (or a graduate from an accredited School of Nursing)
- 3+ years of Behavioral Health hospital acute care/medical experience
- An active, unrestricted State license in good standing, such as LCSW, LPCC, LMFT, or RN
- A valid driver's license with a good driving record and reliable transportation
Preferred Qualifications
While not required, the following qualifications are preferred:
- A 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 (LCSW) licensure
Skills and Competencies
To excel in this role, you will need to possess:
- Strong clinical skills and knowledge of evidence-based clinical guidelines
- Excellent communication and interpersonal skills
- Ability to work independently and as part of a multidisciplinary team
- Strong analytical and problem-solving skills
- Ability to prioritize tasks and manage multiple projects simultaneously
- Proficiency in Microsoft Office and electronic medical records
Career Growth Opportunities and Learning Benefits
At Molina Healthcare, we are committed to the growth and development of our employees. As a Behavioral Health Inpatient Review Clinician, you will have access to:
- Ongoing training and education to enhance your clinical skills and knowledge
- Opportunities for professional growth and advancement within the company
- A collaborative and supportive work environment that fosters teamwork and innovation
- Recognition and reward for outstanding performance and contributions to the company
Work Environment and Company Culture
Our company culture is built on a foundation of respect, empathy, and compassion. We value diversity and inclusion and are committed to creating a work environment that is welcoming and supportive of all employees. As a remote employee, you will be able to work from the comfort of your own home, with the flexibility to create a schedule that works for you.
Compensation, Perks, and Benefits
We offer a competitive benefits and compensation package, including:
- A salary range of $26.41 - $61.79 per hour, depending on experience and location
- Comprehensive health, dental, and vision insurance
- 401(k) retirement plan with company match
- Paid time off and holidays
- Opportunities for professional growth and advancement
Conclusion
If you are a motivated and compassionate healthcare professional looking for a challenging and rewarding role, we encourage you to apply for this exciting opportunity. As a Behavioral Health Inpatient Review Clinician, you will have the chance to make a positive impact on the lives of our members and contribute to the success of our organization. Don't miss out on this opportunity to join our team and take your career to the next level. Apply now!
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