SanDiegoRecruiter Since 2001
the smart solution for San Diego jobs

Care Review Clinician, Inpatient Review (RN)

Company: Molina Healthcare
Location: San Diego
Posted on: May 19, 2019

Job Description:

Job Description Job Summary Molina 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 Education Graduate from an Accredited School of Nursing. Required Experience 3 years hospital acute care/medical experience. Required License, Certification, Association Active, 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 Education Bachelor's Degree in Nursing Preferred Experience Recent hospital experience in ICU, Medical, or ER unit. Preferred License, Certification, Association Utilization Management Certification (CPHM). 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.SDL2017

Keywords: Molina Healthcare, San Diego , Care Review Clinician, Inpatient Review (RN), Other , San Diego, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


$16-$35+/Hour Part Time Jobs Hiring: (Positions Open)
Description: No Experience
Company: PartTime.FindDreamJobs.com
Location: Lake Elsinore
Posted on: 06/17/2019

Part Time Teller (20 Hours) - Placentia Branch
Description: Part Time Teller 20 Hours - Placentia Branch- Description Position Summary: The Teller role is a critical position for selected branch teams in helping the branches achieve its sales, service (more...)
Company: Citibank
Location: Placentia
Posted on: 06/17/2019

OSHPD Superintendent
Description: OSHPD Superintendent br If you are a OSHPD Superintendent with experience, please read on br Top Reasons to Work with Us br 1. Small, caring and supportive company culture br 2. 24 years in business (more...)
Company: CyberCoders
Location: Placentia
Posted on: 06/17/2019


Heavy Truck Mechanic
Description: Are you the Fleet Technician we're looking for at First Transit br If you're a highly skilled mechanic with a strong sense of personal responsibility, a dedication to excellence, and a truly positive (more...)
Company: First Transit
Location: Lake Elsinore
Posted on: 06/17/2019

Costumer Solutions Tech Support
Description: You will be provided the equipment computer and accessories to work from home where you will answer inbound calls from customers across the country and help them troubleshoot their home security and (more...)
Company: Mommy jobs online
Location: El Centro
Posted on: 06/17/2019

CDS Part Time Product Demonstrator
Description: Summary CDS Part Time Product Demonstrator -- Are you outgoing and enthusiastic about interacting with people If promoting the best brands to today---s shoppers sounds appealing, then Club Demonstration (more...)
Company: Club Demonstration Services
Location: Lake Elsinore
Posted on: 06/17/2019

Transit Bus Mechanic
Description: Are you the Fleet Technician we're looking for at First Transit br If you're a highly skilled mechanic with a strong sense of personal responsibility, a dedication to excellence, and a truly positive (more...)
Company: First Transit
Location: Lake Elsinore
Posted on: 06/17/2019

Regional Company Driver - Home Weekly
Description: Now Hiring Company Drivers br Offering Weekly Home Time br Drivers Average 84k Annually br br Truck Driver Benefits: br br br Drivers average 84,000 per year br Drivers are home weekly (more...)
Company: Sherwin Williams
Location: El Centro
Posted on: 06/17/2019

Hair Stylist - Village Center at Rose
Description: Stylist At Great Clips, we know that stylists like you are most happy when they're cutting hair, so at a Great Clips salon, that's exactly what you get to do Want to be the best stylist in
Company: Great Clips
Location: Placentia
Posted on: 06/17/2019

Diesel Mechanic
Description: Are you the Fleet Technician we're looking for at First Transit br If you're a highly skilled mechanic with a strong sense of personal responsibility, a dedication to excellence, and a truly positive (more...)
Company: First Transit
Location: Placentia
Posted on: 06/17/2019

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

San Diego RSS job feeds