Care Review Clinician, Inpatient Review (Bh)

Molina Healthcare Jackson , MS 39201

Posted 2 weeks ago

Job 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.


  • 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

  • Interqual system experience

  • Utilization Management/Review

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.

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

Licensed Clinical Social Worker (Masters Prepared)

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.

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Care Review Clinician, Inpatient Review (Bh)

Molina Healthcare