…managed care (Medicare and/or Medicaid) Experience with managed care (Medicare and Medicaid) utilization review preferred MD or DO; Board certification in an

…and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making

…mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4

…or services (with complete cost/benefit analysis). Oversees all CQI and utilization review activities. Assists in agency evaluation activities. Participates

…are in compliance with governmental and regulatory requirements. + Implement utilization review and quality improvement systems. Implement educational programs

… Review Organization a Plus **Preferred Qualifications:** -Health plan/payor Utilization Management / Review experience. -Electronic medical systems/record

…but not limited to conducting assessments, facilitating didactic and process groups, utilization review , treatment and discharge planning and documentation of

…in the area of billing and coding, medical records, quality assurance, or utilization review . . Medical Technology or Health Information Technology certification

…(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services

…and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing standards and processes and establish new standards and processes