Care Review Clinician, Specialty Therapist
On-siteFlorida, United States
Job Summary
Analyze clinical service requests against evidence-based guidelines to determine medical necessity, benefits eligibility, and expected length of stay. Conduct reviews to establish prior authorization and financial responsibility, process requests within required timelines, and request additional information from members or providers as needed. Refer appropriate cases to medical directors and collaborate with multidisciplinary teams to promote the Molina care model while ensuring services align with clinical guidelines, insurance policies, and regulations. Requires at least two years of experience in acute care, inpatient review, prior authorization, nursing, or managed care, with an active OT, PT, or SLP license.
Required Qualifications
- At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant education and experience
- Occupational Therapist (OT), Physical Therapist (PT), Speech-Language Pathologist (SLP)
- License must be active and unrestricted in state of practice
- Ability to prioritize and manage multiple deadlines
- Excellent organizational, problem-solving and critical-thinking skills
- Excellent verbal and written communication skills
- Microsoft Office suite/applicable software program(s) proficiency
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