Saviance · 4 months ago
Healthcare - Care Review Clinician I
NV
Full-time
Onsite
New Grad, Entry Level
0+ years expSaviance is a healthcare company seeking a Care Review Clinician I to work with the Utilization Management team. The role involves conducting inpatient medical necessity/utilization reviews and ensuring compliance with care delivery standards for Molina Healthcare members.
Information Technology & Services
Responsibilities
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
Qualification
Required
Must align with Molina Healthcare competencies
Able to complete and maintain a daily productivity rate of 15 authorizations a day for concurrent review or 20 authorizations a day for prior authorization
Highly organized
Strong clinical assessment skills
Excellent attention to detail, critical thinking, and effective communication skills in fast-paced, multidisciplinary settings
Ensuring appropriate care delivery, meeting compliance standards, and facilitating collaboration between healthcare providers
Unrestricted Registered Nurse licensure within Nevada upon hire or within 90 days of starting
Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree)
Minimum 0-2 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management
Active, unrestricted State Nursing (RN, LVN, LPN) license in good standing
Preferred
Knowledge of applicable state, and federal regulations
In depth knowledge of Interqual and other references for length of stay and medical necessity determinations
Experience with NCQA
Company
Saviance
Saviance is a modern consulting firm providing a variety of professional services to its clients in the US.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Rohit M.
Managing Partner
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