Saviance · 2 days ago
Care Review Clinician II
CA
Full-time
Onsite
Mid Level
3+ years expSaviance is a company focused on healthcare services, and they are seeking a Care Review Clinician II to join their Utilization Management team. The primary responsibility of this role is to conduct inpatient medical necessity and utilization reviews to ensure Molina Healthcare members receive appropriate care in a timely manner.
Information Technology & Services
Responsibilities
Processing pediatric inpatient authorizations
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
RN
3+ years of experience
Completion of an accredited Registered Nursing program
Active, unrestricted State Nursing (RN, LVN, LPN) license in good standing
Pediatrics, CCS and UM skills
Demonstrated ability to communicate, problem solve, and work effectively with people
Excellent organizational skill with the ability to manage multiple priorities
Work independently and handle multiple projects simultaneously
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
Ability to take initiative and see tasks to completion
Computer Literate (Microsoft Office Products)
Excellent verbal and written communication skills
Ability to abide by Molina's policies
Ability to maintain attendance to support required quality and quantity of work
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers
Preferred
Minimum 2-4 years of clinical practice
Preferably hospital nursing, utilization management, and/or case management
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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