Care Review Clinician (BH Licensed) - Remote in FL

Job Overview

The role of the Care Review Clinician at Molina Healthcare is primarily centered around providing specialized support for member clinical service review processes tailored to behavioral health. This position allows for a remote work environment in Florida, offering flexibility while focusing on a critical aspect of patient care.

Key Responsibilities

In this role, the clinician will be responsible for performing the following essential duties:

• Assessing Services: Evaluate services for members to ensure optimum outcomes and compliance with state and federal regulations. This entails analyzing clinical service requests against established, evidence-based clinical guidelines.

• Eligibility and Benefits Determination: Identify the appropriate benefits, eligibility, and expected duration of stay for requested treatment. This ensures that all requests are managed within the required timelines.

• Prior Authorization Reviews: Conduct reviews to determine prior authorization and financial responsibilities for both Molina and its members. This step is crucial in ensuring that care aligns with insurance policies.

• Collaboration and Information Sharing: Work closely with multidisciplinary teams to uphold the Molina care model and collaborate on providing Applied Behavior Analysis (ABA) and Behavioral Health Therapy (BHT) services to members with developmental disorders.

• Monitoring and Improvement: Continuously monitor treatment plans for effectiveness, making necessary adjustments, and providing recommendations that enhance member progress.

• Documentation and Process Improvement: Responsible for documentation, reviewing assessments, and possibly developing forms and training to improve BHT service delivery and outcomes.

Required Skills and Qualifications

Candidates interested in applying for this role need to meet the following qualifications:

• Healthcare Experience: A minimum of two years of experience in healthcare, particularly in behavioral health and/or hospital acute care, or an equivalent combination of education and experience.

• Licensure: Necessary licensure includes being a Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), or Licensed Marriage and Family Therapist (LMFT). The license must be active and unrestricted in the state of practice.

• Behavioral Analyst Experience: While not mandatory, having behavioral analyst experience and board certification/licensure as a behavioral analyst (BCBA and/or LBA) can enhance applications.

  

• Knowledge and Skill Set: Candidates must demonstrate:

  • Knowledge of Community Resources: Understanding available community resources is vital.
  • Proactivity and Attention to Detail: The ability to take initiative and stay organized is important.
  • Adaptability: Must be able to adjust to different settings, working with diverse populations and personalities.
  • Independence: A self-motivated individual capable of working with minimal supervision is preferred.
  • Strong Communication Skills: This includes both verbal and written communication and the capacity to remain calm under pressure.
  • Problem-Solving Abilities: Excellent critical thinking and problem-solving skills are required.
  • Technical Proficiency: Familiarity with the Microsoft Office suite and other relevant software is needed for effective job performance.

Preferred Qualifications

• Experience in hospital behavioral health, particularly in an Intensive Care Unit (ICU) or emergency room, is favored but not required.

Salary and Benefits

While the specific salary range for this position isn't provided, Molina Healthcare is known for offering a competitive benefits and compensation package. Interested applicants are encouraged to inquire about salary specifics during the interview process or through Molina's internal application portal.

Application Process

Staff members interested in applying for this role are advised to utilize the Internal Job Board at Molina Healthcare. This ensures that current employees can explore advancement opportunities within the company. It’s recommended that candidates prepare a tailored application that highlights relevant experience and skills to facilitate their chances of being selected for an interview.

Conclusion

The Care Review Clinician position at Molina Healthcare presents an exciting opportunity for qualified behavioral health professionals looking to make a significant impact on members' healthcare experiences. With its remote setup, the role not only offers flexibility but also the chance to collaborate with multidisciplinary teams, contributing to the broader strategy of delivering quality and cost-effective member care in the behavioral health domain. Candidates who feel they meet the qualifications should consider applying promptly and take advantage of the internal opportunities available at Molina Healthcare.

This job offer was originally published on himalayas.app