Care Review Clinician, Social Worker - Syracuse, New York

Posted On Mar 5

Job Description

We are excited to Celebrate Molina Healthcare in the New York Market for the several years.  Word is spreading and our membership is expanding and becoming more robust.  We are excited to expand our Services.  


This role in New York is part of a larger Medicaid Behavioral Health role out under the HARP program.  The main purpose is traditional Utilization Management focusing almost entirely on inpatient mental health and substance abuse stays and some outpatient services requiring Prior Authorization.  That represents only a small portion.  These new Behavioral Health services include Home and Community Based Services as outlined by New York Department of Medicaid.  These services are wide and varied and will require Prior Authorization.  You will interface with providers and help to shape care and successful discharges.   Come be a part of transforming the lives of fellow New Yorkers.  


Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.



• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. 

• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 

• Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.

• 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 in consistent and efficient manner.

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

• Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.


Job Qualifications Required Education

Master's Degree in Social Work, Psychology, or other Behavioral Health field

Required Experience

  • 3+ years Behavioral Health hospital acute care/medical experience.
  • Required License, Certification, Association
  • Active, unrestricted State license in good standing, such as LCSW, LPCC or LMFT.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

  • Master's Degree in Clinical Social Work
  • Preferred Experience
  • Recent Behavioral Health hospital experience in ICU, Medical, or ER unit.
  • Preferred License, Certification, Association
  • Licensed Clinical Social Worker (Masters Prepared)


To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.


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

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