Care Review Clinician, Specialty Therapist (Occupational / Physical / Speech) - REMOTE

Job Summary Provides support for member services review assessment activities for a specific area of specialty. Responsible for ensuring that services are medically necessary, align with established clinical guidelines, insurance policies, and regulations, and that members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Analyzes clinical service requests from members and providers against evidence-based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate cases to medical directors, and presents them in a consistent and efficient manner. • Requests additional informa...