Fully Remote***Candidates can sit anywhere in the U.S., but MUST have ILLINOIS RN State License. Schedule is Mon to Friday, 8am-5pm CST, opportunity for a 10 hour shift, some weekend and holidays will be required.
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities. Must be experienced working in acute care/medical surgical. The area of expertise is specific to inpatient reviews. Must have solid experience within a clinical setting as you will need to be able to use your knowledge to extrapolate key information during the authorization process.
- Provides concurrent review and prior authorizations (as needed) according to healthcare policy for Healthcare 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
Requirements
- ILLINOIS RN State License is required
- Experience working in acute care/medical surgical. Their area of expertise should be specific to inpatient reviews and must have solid experience within a clinical setting as they will need to be able to use their knowledge to extrapolate key information during the authorization process.