Job Summary
A healthcare company has an open position for a Remote Inpatient Review Care Review Clinician.
Core Responsibilities of this position include:
- Analyzing clinical service requests from members or providers against evidence based clinical guidelines
- Conducting inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed
- Requesting additional information from members or providers in consistent and efficient manner
Qualifications for this position include:
- Bachelor's Degree in Nursing
- Active, unrestricted Utilization Management Certification (CPHM)
- Recent hospital experience in ICU, Medical, or ER unit
- 3+ years hospital acute care/medical experience
- Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation
