Care Review Clinician II
Location: Troy Michigan
Description: Molina Healthcare is in need of Care Review Clinician II right now, this career will be placed in Michigan. Further informations about this career opportunity please read the description below. Molina Healthcare has an immediate opportunity for two (2) Care Review Clinician II at our Troy, MI location. This role works within the Care Access and Monitoring (CAM) team to provide clerical and data en! try support for Molina Members that require hospitalization and/or utilization review for other healthcare services. Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the appropriate Health Care Services staff to ensure the delivery of integrated high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes for Molina Members.
Duties and Responsibilities
- Provide computer entries of authorization request/provider inquiries by phone, mail, or fax. Including:
Determine provider contracting status and appropriateness
Determine diagnosis and treatment request
Determine COB status
Verify inpatient hospital census-admits and discharges
Perform action required per protocol using the appropriate Database
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- Meet department productivity standards.
- Respond ! to requests for authorization of services submitted to CAM via phone, fax and mail according to Molina operational timeframes.
- Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.
- Provide excellent customer service for internal and external customers.
- Meet department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores.
- Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status.
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
- Participate in Care Access and Monitoring meetings as an active member of the team.
- Meet attendance guidelines per Molina Healthcare policy.
- Follow “Standards of Conduct†guidelines as described i! n Molina Healthcare HR policy.
- Comply with required workplace safety standards.
- Demonstrated ability to communicate, problem solve, and work effectively with people.
- Working knowledge of medical terminology and abbreviations.
- Ability to think analytically and to problem solve.
- Good communication and interpersonal/team skills.
- Must have a high regard for confidential information.
- Ability to work in a fast paced environment.
- Able to work independently and as part of a team.
- Computer skills and experienced user of Microsoft Office software.
- Accurate data entry at 40 WPM minimum.
- Other duties as assigned.
Required Education:
- High School Diploma/GED
- Associates in Arts degree or other degree
- Previous Hospital or Healthcare clerical or billing ex! perience.
- One year or more in a Managed Care Environment
- Hospital billing or coding.
- Certified Clinical Coder
Molina Healthcare offers competitive benefits and compensation package.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Molina Healthcare.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Tue, 02 Apr 2013 02:10:38 GMT