Care Review Clinician, IP Review (BH) LICSW, LMFT, LMHC Remote in WA

As a Care Review Clinician at Molina Healthcare, your primary responsibilities include assessing inpatient services, analyzing clinical service requests against evidence-based guidelines, and determining the financial responsibility for treatments. Your role also involves making referrals to clinical programs, processing requests within required timelines, and collaborating with multidisciplinary teams to support members in achieving their healthcare goals.

To become a Care Review Clinician at Molina Healthcare, you need to hold a Master’s Degree in Social Work, Psychology, or a related Behavioral Health field, along with an active, unrestricted state license such as LICSW, LMFT, or LMHC. Additionally, having at least 3 years of experience in behavioral health hospital settings is crucial for success in this role.

Yes, the Care Review Clinician position at Molina Healthcare is fully remote, allowing you to work from the comfort of your home in Washington. However, you will need to be available to work during PST hours and may occasionally need to travel to Molina offices or hospitals based on the state plan requirements.

A typical day for a Care Review Clinician at Molina Healthcare involves reviewing inpatient services, analyzing service requests, and communicating with clinical teams regarding treatment plans. You will manage your schedule independently within a fast-paced environment, ensuring that requests are processed efficiently while maintaining compliance with healthcare regulations.

Molina Healthcare offers comprehensive support to its Care Review Clinicians, including training, resources for professional development, and a collaborative work culture that emphasizes teamwork and shared goals. The company is committed to providing a competitive benefits package to support your well-being and career growth.

When answering this question, highlight your previous experiences in managed care, emphasizing specific examples where you assessed clinical requests or worked within utilization management. Showcase how these experiences have equipped you to ensure quality care and adherence to regulations as a Care Review Clinician.

To effectively prioritize tasks in a high-volume environment, I focus on organizing my workload based on urgency and importance. I use checklist tools to track pending requests and deadlines, ensuring that I meet required timelines while maintaining quality assessments and compliance standards.

I utilize a systematic approach to analyze clinical service requests, first reviewing the details against established evidence-based guidelines. I also consider the patient’s history, symptoms, and any supporting documentation to make informed decisions, which can involve consultation with other professionals when necessary.

When faced with disagreements, I believe in maintaining open communication and fostering a collaborative approach. I present all relevant data and rationale for my recommendations, and I’m open to discussing alternative perspectives to reach a consensus that benefits the patient’s care.

I am drawn to Molina Healthcare's mission of providing accessible and quality care for underserved populations. As someone who is passionate about behavioral health, I believe this role allows me to make a significant impact while working alongside a dedicated team committed to member well-being.

In my previous role, I encountered a case with conflicting treatment recommendations. I overcame the challenge by thoroughly reviewing the patient’s history and collaborating with multidisciplinary teams to gather additional perspectives. By facilitating open discussions, I was able to develop a comprehensive care plan that satisfied all parties.

I have experience using electronic health record (EHR) systems, clinical decision support tools, and utilization management software. My proficiency in these technologies allows me to manage patient data efficiently and ensure timely decision-making in care reviews.

I stay updated by attending professional workshops, participating in webinars, and subscribing to reputable behavioral health journals. Joining professional organizations also allows me to engage with colleagues, sharing insights and learning about the latest trends and best practices in the field.

Building relationships with providers and team members relies on consistent communication and mutual respect. I prioritize being approachable and open to feedback, which fosters collaboration and trust, ensuring that we work together effectively in making informed decisions for patient care.

To ensure compliance, I meticulously familiarize myself with state and federal regulations related to healthcare. During case reviews, I refer to these guidelines, documenting my assessments and decision-making processes to reflect adherence and accountability in all aspects of my work as a Care Review Clinician.