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Care Review Clinician, Inpatient Review (BH) - Remote

Posted 4 days ago
All others
Full Time
USA

Overview

The Care Review Clinician at Molina Healthcare Services plays a crucial role in assessing and coordinating care for members with high needs, ensuring quality and cost-effective outcomes.

In Short

  • Work with multidisciplinary teams to coordinate care.
  • Requires New York LMHC, LCSW, or LMSW licensure.
  • Experience in UM and Inpatient Review is essential.
  • Analyze clinical service requests against evidence-based guidelines.
  • Conduct inpatient reviews and prior authorization reviews.
  • Collaborate with Medical Directors on complex cases.
  • Maintain compliance with state and federal regulations.
  • Work schedule is Monday to Friday with occasional weekend rotation.
  • 3+ years of experience in Behavioral Health required.
  • Active driving license is necessary for occasional travel.

Requirements

  • Master's Degree in Social Work, Psychology, or related field.
  • 3+ years of acute care/medical experience in Behavioral Health.
  • Active and unrestricted state license (LCSW, LPCC, LMFT).
  • Preferred: Recent experience in Behavioral Health hospital settings.
  • Strong analytical and communication skills.
  • Ability to work independently in a high-volume environment.
  • Familiarity with NYS Medicaid guidelines.
  • Good driving record and reliable transportation.

Benefits

  • Competitive benefits and compensation package.
  • Opportunities for professional development.
  • Supportive work environment with a focus on quality care.
  • Equal Opportunity Employer.

M.T.A

Molina Talent Acquisition

Molina Healthcare is a leading provider of managed healthcare services, dedicated to improving the health of its members through high-quality, cost-effective care. The company focuses on network strategy and development, ensuring compliance with federal, state, and local regulations while aligning with its core values and strategic goals. Molina Healthcare emphasizes the importance of building strong relationships with complex providers, including hospitals and physician groups, to enhance network adequacy and financial performance. With a commitment to value-based care, Molina Healthcare actively engages in contract negotiations and innovative reimbursement models to meet the diverse needs of its members.

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