Care Review Clinician, Inpatient Review (RN): Remote, CALIFORNIA ( 3 - 12 shift )
Molina Healthcare Arizona; Columbus, Georgia; Davenport, Iowa; Lincoln, Nebraska; Kenosha, Wisconsin; Salt Lake City, Utah; Ohio; Washington; Wisconsin; Tucson, Arizona; Tampa, Florida; Lexington-Fayette, Kentucky; Ann Arbor, Michigan; Las Cruces, New Mexico; Spokane, Washington; Akron, Ohio; West Valley City, Utah; Idaho; Kentucky; New York; Texas; Chandler, Arizona; Meridian, Idaho; Des Moines, Iowa; Cedar Rapids, Iowa; Grand Rapids, Michigan; Seattle, Washington; Rio Rancho, New Mexico; Rochester, New York; Green Bay, Wisconsin; Cincinnati, Ohio; Dallas, Texas; Orem, Utah; Georgia; Michigan; Phoenix, Arizona; Scottsdale, Arizona; Miami, Florida; St. Petersburg, Florida; Idaho Falls, Idaho; Sioux City, Iowa; Louisville, Kentucky; Albuquerque, New Mexico; Santa Fe, New Mexico; Vancouver, Washington; New York, New York; Austin, Texas; Florida; Orlando, Florida; Atlanta, Georgia; Augusta, Georgia; Caldwell, Idaho; Owensboro, Kentucky; Tacoma, Washington; Milwaukee, Wisconsin; Madison, Wisconsin; Dayton, Ohio; Houston, Texas; Utah; Nebraska; Savannah, Georgia; Boise, Idaho; Grand Island, Nebraska; Roswell, New Mexico; Bellevue, Washington; Provo, Utah; Iowa; Jacksonville, Florida; Macon, Georgia; Detroit, Michigan; Omaha, Nebraska; Kearney, Nebraska; Buffalo, New York; Columbus, Ohio; San Antonio, Texas; Cleveland, Ohio; Fort Worth, Texas; New Mexico; Mesa, Arizona; Nampa, Idaho; Iowa City, Iowa; Bowling Green, Kentucky; Covington, Kentucky; Warren, Michigan; Sterling Heights, Michigan; Bellevue, Nebraska; Yonkers, New York; Syracuse, New York; Racine, Wisconsin; Layton, Utah Job ID 2030024EMERGENCY ROOM ADMISSIONS REVIEW NURSEÂ
1 opening for 12 hour NIGHT SHIFT:Â 7:30PM (in the evening) - 08:30AM Â (in the morning) PACIFIC HOURS NON EXEMPT, 3 days a week will rotate.Â
1 opening for 12 hour DAY SHIFTÂ 8:30AM (in the morning) - 7:30PM (in the evening) PACIFIC HOURS NON EXEMPT, 3 days a week will rotate.
TRAINING SCHEDULE WILL BE Monday thru Friday  8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift after training is completed. Training hours are mandatory.Â
This position supports our California Health Plan. Candidates can live anywhere in the USA if they have a valid CALIFORNIA RN license and must work  the Pacific Time Zone shift hours as posted.Â
JOB DESCRIPTION
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.
KNOWLEDGE/SKILLS/ABILITIES
- 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
Graduate from an Accredited School of Nursing.
Required Experience
3+ years hospital acute care/medical experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
State Specific Requirements:
CA Â Qualifications: Licensed within the state of California
Preferred Education
Bachelor's Degree in Nursing
Preferred Experience
Previous work experience in hospital Acute care including 2 years in ER or ICU
Previous work experience with InterQual or MCG guidelines
Pay Range: $23.76 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 02/12/2025ABOUT OUR LOCATION
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