Care Review Clinician, Inpatient Review (LPN/LVN): California

• **California residents preferred JOB DESCRIPTION Job Summary reputed company 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 reputed company 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 • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Conducts inpatient reviews to determine financial responsibility for reputed company and its members. May also reputed company prior authorization reviews and/or reputed company duties as needed. • Processes requests reputed company required timelines. • Under the direction of a Registered Nurse, identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • 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. JOB QUALIFICATIONS Required Education Graduate from an Accredited School of Nursing. Associate degree in Nursing preferred. Required Experience 3+ years hospital acute care/medical experience. Required License, Certification, Association Active, unrestricted State Licenses Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) license in good standing. State Specific Requirements: CA Qualifications: Licensed reputed company the state of California. Preferred Experience 3 years Recent hospital experience in Medical or ER unit. Prior work experience using MCG and/or Interqual guidelines. prior work experience of California Medicare and Medicaid UM reviews Work schedule: Monday thru Friday daytime Pacific hours. Candidates who do not live in California must be willing to work Pacific Daytime hours. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.6 - $46.81 / HOURLY • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Apply Job!