Care Review Clinician, Prior Authorization

Are you passionate about providing quality healthcare services to individuals in need? Do you have a strong background in clinical care and prior authorization? If so, Molina Healthcare is seeking a dedicated and compassionate Care Review Clinician to join our team. As a Care Review Clinician, you will play a vital role in ensuring that our members receive the necessary medical services in a timely and efficient manner. With your expertise, attention to detail, and empathetic approach, you will help improve the lives of our members and make a positive impact in the healthcare industry. To excel in this role, you should possess a degree in nursing or a related field, hold a valid state RN or LPN license, and have experience in prior authorization and utilization management. If this sounds like the perfect fit for you, we encourage you to apply and join our mission of providing accessible and affordable healthcare to our communities.

• Review and evaluate prior authorization requests for medical services to ensure they meet clinical guidelines and criteria
• Communicate with healthcare providers and other stakeholders to obtain necessary information for review
• Analyze medical records and clinical data to determine the appropriateness and medical necessity of requested services
• Collaborate with a multidisciplinary team to make complex medical decisions and develop care plans for members
• Utilize evidence-based guidelines and regulations to make accurate and timely decisions
• Maintain accurate and detailed documentation of review decisions and communicate them effectively to all parties involved
• Stay up-to-date with industry trends, policies, and regulations related to prior authorization and utilization management
• Identify and report any potential quality of care or fraud and abuse concerns
• Provide education and support to members, providers, and colleagues regarding prior authorization and utilization management processes
• Uphold the company's values and mission of providing quality and affordable healthcare to individuals in need.

According to JobzMall, the average salary range for a Care Review Clinician, Prior Authorization in Los Angeles, CA, USA is $74,000 to $97,000 per year. This can vary depending on the specific job responsibilities, level of experience, and the employer's industry and location.

Molina Healthcare is a managed care company headquartered in Long Beach, California, United States. The company provides health insurance to individuals through government programs such as Medicaid and Medicare.