$26.41–$51.49/hr
Care Review Clinician (BH Licensed) - Remote in FL
Molina Healthcare · Centralia, WA
Job description
JOB DESCRIPTION Job Summary Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations, and ensuring membersreach 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 • Assesses services for members - ensuring optimum outcomes, cost-effectiveness and compliance with all state/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 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 cases in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote Molina care model. • Adheres to utilization management (UM) policies and procedures. • May work collaboratively with appropriate departments to provide applied behavior analysis (ABA)/behavioral health therapy (BHT) services to Molina members with autism spectrum disorder (ASD) and other related disorders. • May approve requests for BHT by reviewing behavioral assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not limited to: psychological evaluation requests, comprehensive diagnostic evaluations, functional behavioral assessments, and progress reports. • May perform ongoing monitoring of BHT treatment plans to evaluate effectiveness and treatment efficacy. • May provide peer to peer consultation BHT in-network providers to support treatment planning and maximize member progress. • May work collaboratively with ABA providers to ensure best service practices for members. • May create and develops forms, recommendations and guidelines and training for BHT service delivery. • May collaborate and coordinate with behavioral health medical directors, and senior medical directors to ensure proper management of the BHT benefit. Required Qualifications • At least 2 years health care experience, including experience in behavioral health and/or hospital acute care, or equivalent combination of relevant education and experience. • Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT) or equivalent behavioral health licensure. License must be active and unrestricted in state of practice. • May require behavioral analyst experience, and/or board certification/licensure as a behavioral analyst (BCBA and/or LBA). • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsive in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Recent hospital behavioral health experience in an intensive care unit (ICU) or emergency room. #PJHS3 #LI-AC1 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.
More jobs in Centralia, WA
Behavioral Health Care Planner
CVS Health · Centralia, WA
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and qualityin everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. Care Planner - Behavioral Health (Work at Home, U.S.) Schedule: Monday-Friday, 11:00 AM-7:30 PM EST (Some company holiday and weekend coverage may be required) Location: Work from your home, anywhere in the United States About the Role Join the Behavioral Health Division of Aetna/CVS Health as a Care Planner, where you'll play a meaningful part in helping members access the behavioral health support and documentation they need. In this role, you'll collaborate with Medical Directors, clinicians, and customer service teams to support higher-level case reviews and ensure timely, accurate processing. You'll also help maintain our state regulatory compliance and support our NCQA accreditation-key functions that keep our care programs running smoothly and effectively. What You'll Do • Support clinical teams to enhance the quality and coordination of member care • Prepare administrative and medical-necessity determination letters with accuracy and clarity • Communicate results of medical reviews to providers and utilization teams, including next steps • Schedule and coordinate appointments between providers and Aetna Medical Directors or Consultants • Gather appropriate documentation for clinical appointments and track deadlines to ensure timely completion • Ensure compliance with state requirements and Aetna policies, using strong attention to detail across varying protocols Required Qualifications: • 2+ years of experience in at least one of the following: • Health insurance • Administrative/secretarial work • Customer service within a healthcare or mental health environment • Ability to type 60-70 words per minute • Proficiency with Microsoft Office Suite (Outlook, Word, Excel) Preferred Qualifications • Strong organizational and time-management abilities • Excellent written and verbal communication skills Education • Associate degree or equivalent experience, i.e healthcare industry experience. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 - $44.99 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 07/23/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Logistics Coordinator Tues-Sat 6:00AM- 4:30PM EST ( Remote local to Miami )
UPS US · Centralia, WA
Explore Your Next Opportunity At UPS Healthcare Envision innovative possibilities, experience our rewarding culture, and work with talented teams that help you become better every day. We know what it takes to lead UPS into tomorrow—people with a unique combination of skill + passion.If you have the qualities and drive to lead yourself or teams, there are roles ready to cultivate your skills and take you to the next level. Job Description Together, we are Marken, UPS Healthcare Precision Logistics. As the clinical and advanced therapy part of UPS Healthcare, we reach patients faster, with greater scalability and access to new pathways throughout the supply chain. With our One UPS advantage and comprehensive service portfolio, including Polar Speed's in-network pharmacies, we are optimally positioned to keep our clients competitive in an increasingly complex market. Work Location This position will begin in a temporary remote capacity. We anticipate transitioning the position to an on-site Miami, Florida office. During these periods, all responsibilities, reporting structure, and performance expectations will remain the same. The temporary remote arrangement will be reviewed regularly. Any changes will be communicated in advance to ensure a smooth transition to an on-site role. Candidates must be able to commute when on-site work resumes. What You Will Do • Handle incoming customer requests via phone, email and website with a sense of urgency and attention to detail • Using MNX's proprietary logistics management platform, process, monitor, and manage critical customer shipments for the medical, aerospace, telecommunications and high tech industries • Communicate with customers and agents in a professional and courteous manner • Meet required team metrics • Stay current on all required training What You Bring • At least 1 year of customer service experience • Time Management • Must be at least 18 years old and have a high school diploma or GED • Be proficient in: Microsoft-Word, Excel, Outlook & data entry and type 30 WPM • Knowledge of US and world geography and time zones is preferred • Call Center experience is preferred • Must have outstanding communication, customer service, and organizational skills • Be able to operate in a fast-paced and demanding environment • Be flexible - with the ability to work additional hours as business requires Shift / Hours: Tues-Sat 6:00AM- 4:30PM EST Must be able to train Monday - Friday 8:00am - 5:00pm EST for 3-4 weeks. Employee Type: Permanent UPS is committed to providing a workplace free of discrimination, harassment, and retaliation. UPS is an equal opportunity employer. UPS does not discriminate on the basis of race/color/religion/sex/national origin/veteran/disability/age/sexual orientation/gender identity or any other characteristic protected by law. Must be a U.S. Citizen or National of the U.S., an alien lawfully admitted for permanent residence, or an alien authorized to work in the U.S. for this employer.
Dedicated Reefer CDL-A Truck Driver Jobs ($1,800+/Wk) Quick Apply!
Hiring Drivers Now · Centralia, WA
Dedicated Reefer CDL-A Truck Driver Jobs ($1,800+/Wk) Quick Apply! Apply today and within 24 hours you'll receive multiple job offers. Earn up to $1,800+/Wk based on position/location. Simply select the driving job that offers you what is most important. Higher pay, increased benefits or more home-time: You choose. Dedicated Reefer Driver Pay: Up to $1,800+/Wk Avg. Company Driver Job Offers Salary: $85,000-$110,000+ Avg. Owner Operator Job Offers Salary: $200,000-$325,000+ Apply now to receive your job offers!
$18/hr
Call Center Rep / Pharmacy Tech Support (Remote-Friendly in the US)
Avery Healthcare Group · Centralia, WA
Pharmacy Support Call Center Representative As the only global provider of commercial solutions, IQVIA understands what it takes to deliver nationally and internationally. Our teams help biopharma, medical device and diagnostic companies get their therapies to the people who need them. We help customers gain insight and access to their markets and ultimately demonstrate their product's value to payers, physicians, and patients. A significant part of our business is providing patient support programs on the behalf of our customers. With the right experience, you can help provide support to patients in need of available therapies. IQVIA has the world's largest Commercial Sales & Medical Solutions (CSMS) organization dedicated to the launch and marketing of pharmaceutical and medical products. With a focus on providing talent for patient support, field/inside sales, medical device support, clinical support, and medical affairs our CSMS division has 10,000+ field professionals in more than 30 countries addressing physician and patient needs. We are excited to announce that currently we are looking for a 100% remote (work from home—WFH) contract Pharmacy Support Call Center Representative to join our team. In this position, you will provide payment assistance solutions such as co-pay cards or vouchers. The Pharmacy Support Call Center Representative is primarily responsible for fielding requests such as: card activation, program eligibility, explanation of program benefit and explanation/troubleshooting of submission rejection. Role Purpose Primary Call Center contact for patients, pharmacies and medical professionals utilizing an Opus Health program. Call Center Representatives are responsible for fielding requests such as: card activation, program eligibility, explanation of program benefit and explanation/troubleshooting of submission rejection. Job Responsibilities • Provide initial support for customer requests via telephone, email, fax, or other available means of contact to the Support Center • Quickly assess the user's issue and provides first level support for problem resolution • Document information specific to the resolution and escalate unresolved issues expeditiously to the appropriate area • Recognize operational challenges and suggest recommendations to management, as necessary • Ability to work 40 hours per week (shifts available: 8:00 am - 5:00 pm EST or, 9:00 am – 6:00 pm EST or, 10:00 am - 7:00 pm ET or, 11:00 am EST – 8:00pm EST) under moderate supervision Minimum Education & Experience • High School Diploma or equivalent • Pharmacy Technician experience required • HIPAA certified • Call center experience required (3+ years preferred) • Experience in medical claim processing is a plus • Bi-lingual (English/Spanish) is a plus The pay range for this role is $18.00 per hour. IQVIA is an Equal Opportunity Employer. We cultivate a diverse corporate culture across the 100+ countries where we operate, celebrating and rewarding teamwork and inclusiveness. By embracing our differences, we create innovative solutions that are good for IQVIA, our clients, and the advancement of healthcare everywhere. This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee.