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JOB DESCRIPTION

For this position we are seeking a TX licensed Occupational Therapist to join the utilization management team conducting reviews for cases requiring OT services. Preference will be given to those OTs who have worked with and have a high level of knowledge of Interqual/MCG guidelines. Excellent computer, multi-tasking skills, and analytical thought processes are important to be successful in this role. Productivity is important with specific turnaround times that must be met. Further details to be discussed during our interview process.

This department operates 365 days a year and we need staff who can be flexible and willing to work some weekends and holidays. This is a REMOTE position working from home. Please consider that scheduling flexibility is important before you apply to this role.

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 information from members or providers as needed.

• Makes member referrals to other clinical programs as appropriate.

• Collaborates with multidisciplinary teams to promote the Molina care model.

• Adheres to applicable utilization management policies and procedures.

Required Qualifications

• At least 2 years experience in a hospital acute care, inpatient review, prior authorization, and/or managed care setting, or equivalent combination of relevant education and experience.

• Occupational Therapist (OT). 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.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $26.41 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.