LPN Care Review Clinician, Prior Authorization Remote in WA state

Lensa - Spokane, WA

Job Title: LPN Care Review Clinician, Prior Authorization Remote in WA state

Position: Nurse Care Manager for the Washington State Plan

Job Type: Full Time

Pay: $21.82 - $48.94 / HOURLY

Shift: Monday- Friday 8:00am- 5:00pm PST including rotational Sunday/Holiday coverage

Work Type: On-Site

Location

Address:

City: Spokane

State: WA

ZIP Code:

Job Responsibilities

Assess 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 and eligibility for requested treatments and/or procedures.
Conduct prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
Process requests within required timelines.
Refer appropriate prior authorization requests to Medical Directors.
Request additional information from members or providers in a consistent and efficient manner.
Make appropriate referrals to other clinical programs.
Collaborate with multidisciplinary teams to promote Molina Care Model.
Adhere to Utilization Management policies and procedures.
Occasional travel to other Molina offices or hospitals as requested.

Required Skills

Core Skills

Clinical assessment
Analytical skills
Knowledge of state and federal regulations
Utilization management
Collaboration with multidisciplinary teams

Preferred Skills

Experience in managed care
Active Utilization Management Certification (CPHM)

Requirements

Experience: 1-3 years of hospital or medical clinic experience

Education: Completion of an accredited RN, LVN, or LPN Program or a bachelor's or master's degree in a healthcare field.

License & Certification:

Active, unrestricted State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license
LCSW, LPCC, or LMFT (for Behavioral Health Care Review Clinicians only)

Schedule:

Regular hours: Monday- Friday 8:00am- 5:00pm PST
Rotational Sunday/Holiday coverage

COVID-19 Requirements: Not Specified

Benefits

Competitive benefits and compensation package

Supplemental Pay

Not specified

Special Notes

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Facility Details

Name: Lensa

Description: Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care.

Specialties: