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LVN Care Review Clinician, Prior Authorization
Molina Healthcare Dallas, Texas; Warren, Michigan; Mesa, Arizona; Atlanta, Georgia; Scottsdale, Arizona; Madison, Wisconsin; Boise, Idaho; West Valley City, Utah; Phoenix, Arizona; Salt Lake City, Utah; Everett, Washington; Kenosha, Wisconsin; Columbus, Georgia; Augusta, Georgia; Orlando, Florida; Vancouver, Washington; Lincoln, Nebraska; Wisconsin; Tacoma, Washington; Omaha, Nebraska; Albuquerque, New Mexico; Spokane, Washington; Chandler, Arizona; Louisville, Kentucky; Cedar Rapids, Iowa; Miami, Florida; Detroit, Michigan; Houston, Texas; Iowa; New Mexico; Ann Arbor, Michigan; Akron, Ohio; Jacksonville, Florida; Bowling Green, Kentucky; Lexington-Fayette, Kentucky; Sterling Heights, Michigan; Cincinnati, Ohio; Fort Worth, Texas; Columbus, Ohio; Grand Island, Nebraska; Milwaukee, Wisconsin; Sioux City, Iowa; Nampa, Idaho; Dayton, Ohio; New York; Utah; Cleveland, Ohio; Austin, Texas; Rio Rancho, New Mexico; Roswell, New Mexico; Kearney, Nebraska; Idaho Falls, Idaho; Ohio; Michigan; Syracuse, New York; Bellevue, Nebraska; Tampa, Florida; Tucson, Arizona; Rochester, New York; Macon, Georgia; Las Cruces, New Mexico; Grand Rapids, Michigan; Kentucky; Green Bay, Wisconsin; Texas; Florida; Georgia; St. Petersburg, Florida; Racine, Wisconsin; Iowa City, Iowa; Owensboro, Kentucky; Des Moines, Iowa; Yonkers, New York; Washington; Idaho; Layton, Utah; San Antonio, Texas; Santa Fe, New Mexico; Buffalo, New York; Albany, New York; Meridian, Idaho; Bellevue, Washington; Caldwell, Idaho; Provo, Utah; Savannah, Georgia; Covington, Kentucky; Nebraska; Davenport, Iowa; Orem, Utah Job ID 2033161JOB 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 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 and eligibility for requested treatments and/or procedures.
- Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
- Processes requests within required timelines.
- Refers appropriate prior authorization requests to Medical Directors.
- 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
Any of the following:
Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a bachelor’s or master’s degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only).
Required Experience
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing OR a clinical license in good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only).
Preferred Experience
3-5 years clinical practice with managed care, hospital nursing or utilization management experience.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
MULTI STATE / COMPACT LICENSURE required.
Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI
WORK SCHEDULE: Sun - Thurs / Tues - Sat shift will rotate with some holidays.
Training will be held Mon - Fri
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
Pay Range: $21.82 - $51.06 / 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 08/13/2025Job Alerts
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