Remote- Candidates need to work EST and be located in FLORIDA. Position is for inpatient admissions/concurrent Behavioral Health Review.
Behavioral Health Experienced Required for Concurrent Review.
What are the must-have requirements that you will be looking for on the resume? Florida licensed ( any of these licenses: RN, LMHC, LCSW). If RN, Behavioral Health knowledge and background.
Candidate must be one of the following: RN, LMHC, LCSW
Schedule will be Monday to Friday 8am – 5pm EST
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Essential Functions: Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care. Maintains department productivity and quality measures. Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to Molina medical directors regularly, as necessary. Complies with required workplace safety standards.
• 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.
Master's Degree in Social Work, Psychology, or other Behavioral Health field or
Bachelor’s Degree in Nursing
3+ years Behavioral Health hospital acute care/medical experience.
Required License, Certification, Association
• Active, unrestricted State license in good standing, such as LCSW, LPCC, LMHC, LMFT or RN
State Specific Requirements:
Qualifications: Licensed within the state of Florida. 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.
Recent Behavioral Health hospital experience in ICU, Medical, or ER unit.