United States onlyJOB 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.
We are seeking a candidate with a New York LMHC, LCSW, or LMSW licensure, UM and Inpatient Review experience. The Care Review Clinician must be able to work independently in a high-volume environment. Candidates with managed care organization (MCO),NYS Medicaid guidelines, and Behavioral Health experience are highly preferred. Further details to be discussed during our interview process.
Remote- requires NY LMHC, LCSW, or LMSW license
Work schedule: Monday - Friday 8:30am - 5:00pmPM EST with rotating 1 weekend every 5-6 weeks and holiday
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
Master's Degree in Social Work, Psychology, or other Behavioral Health field
Required Experience
3+ years Behavioral Health hospital acute care/medical experience.
Required License, Certification, Association
- Active, unrestricted State license in good standing, such as LCSW, LPCC or LMFT.
- Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
State Specific Requirements:
IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment. Master’s Degree in Social Work, Psychology, or other Behavioral Health field, or graduate from an accredited School of Nursing. Active, unrestricted State license in good standing, such as LCSW, LPCC, LMFT or RN.
Preferred Education
Master's Degree in Clinical Social Work
Preferred Experience
Recent Behavioral Health hospital experience in ICU, Medical, or ER unit.
Preferred License, Certification, Association
Active and unrestricted Licensed Clinical Social Worker
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.
