Care Review Clinician, Inpatient Review (RN)
Molina Healthcare Everett, Washington; Albany, New York; Ohio; Texas; Georgia; Michigan; New York; Kentucky; Nebraska; Iowa; Washington; Idaho; New Mexico; Wisconsin; Utah; Florida; Milwaukee, Wisconsin; Nampa, Idaho; Idaho Falls, Idaho; Las Cruces, New Mexico; Provo, Utah; Bowling Green, Kentucky; Dayton, Ohio; Caldwell, Idaho; Mesa, Arizona; Dallas, Texas; Cleveland, Ohio; Sterling Heights, Michigan; Buffalo, New York; Yonkers, New York; Owensboro, Kentucky; Kearney, Nebraska; Madison, Wisconsin; Kenosha, Wisconsin; Tucson, Arizona; Cincinnati, Ohio; Fort Worth, Texas; Warren, Michigan; Tacoma, Washington; Rochester, New York; Omaha, Nebraska; Phoenix, Arizona; Chandler, Arizona; Albuquerque, New Mexico; Roswell, New Mexico; West Valley City, Utah; Orem, Utah; Detroit, Michigan; Bellevue, Washington; Jacksonville, Florida; Orlando, Florida; Des Moines, Iowa; Macon, Georgia; Houston, Texas; Santa Fe, New Mexico; Savannah, Georgia; Augusta, Georgia; Atlanta, Georgia; Rio Rancho, New Mexico; Grand Rapids, Michigan; Covington, Kentucky; Lexington-Fayette, Kentucky; Lincoln, Nebraska; Cedar Rapids, Iowa; Racine, Wisconsin; Columbus, Ohio; Columbus, Georgia; Salt Lake City, Utah; Seattle, Washington; Vancouver, Washington; Miami, Florida; Sioux City, Iowa; Davenport, Iowa; Iowa City, Iowa; Boise, Idaho; Meridian, Idaho; Layton, Utah; Tampa, Florida; New York, New York; Green Bay, Wisconsin; Scottsdale, Arizona; Austin, Texas; San Antonio, Texas; Akron, Ohio; Ann Arbor, Michigan; Spokane, Washington; St. Petersburg, Florida; Syracuse, New York; Louisville, Kentucky; Bellevue, Nebraska; Grand Island, Nebraska Job ID 2031268JOB 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.
Preferred Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.Â
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
MULTI STATE / COMPACT LICENSURE
WORK SCHEDULE: Mon - Fri / Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.
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: $26.41 - $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: 04/10/2025ABOUT OUR LOCATION
View Map- Field Family Nurse Practitioner (Los Angeles, CA) Los Angeles California 03/27/2025
- Field Family Nurse Practitioner (Fresno, CA) Fresno California, Clovis California, Madera California, Kerman California, Selma California, Kingsburg California, Reedley California, Fowler California, Parlier California, Sanger California 03/06/2025
- Senior Business Analyst (Medicare Enrollment) Grand Island Nebraska, Miami Florida, Idaho Falls Idaho, Albuquerque New Mexico, Rio Rancho New Mexico, Warren Michigan, Mesa Arizona, Green Bay Wisconsin, Ann Arbor Michigan, Provo Utah, Scottsdale Arizona, Orem Utah, Owensboro Kentucky, Kearney Nebraska, Detroit Michigan, Macon Georgia, Wisconsin, Fort Worth Texas, Chandler Arizona, Everett Washington, Davenport Iowa, Kentucky, Racine Wisconsin, Tucson Arizona, Roswell New Mexico, Salt Lake City Utah, Nebraska, Madison Wisconsin, Kenosha Wisconsin, Rochester New York, Cincinnati Ohio, Tampa Florida, Washington, Michigan, Texas, Yonkers New York, Dallas Texas, Iowa, Georgia, Syracuse New York, Las Cruces New Mexico, Sioux City Iowa, Covington Kentucky, New York, Cleveland Ohio, Layton Utah, Orlando Florida, St. Petersburg Florida, Columbus Ohio, Omaha Nebraska, Houston Texas, Tacoma Washington, Idaho, Phoenix Arizona, Buffalo New York, Sterling Heights Michigan, Florida, New Mexico, Santa Fe New Mexico, Louisville Kentucky, Des Moines Iowa, Albany New York, Caldwell Idaho, Bellevue Washington, Milwaukee Wisconsin, Vancouver Washington, San Antonio Texas, Boise Idaho, Jacksonville Florida, Atlanta Georgia, Lexington-Fayette Kentucky, Nampa Idaho, Utah, Ohio, West Valley City Utah, Bowling Green Kentucky, Savannah Georgia, Cedar Rapids Iowa, Columbus Georgia, Meridian Idaho, Austin Texas, Dayton Ohio, Spokane Washington, Lincoln Nebraska, Akron Ohio, Iowa City Iowa, Grand Rapids Michigan, Bellevue Nebraska, Augusta Georgia 05/29/2025
- Sr Program Manager (Remote - State of CA ONLY) Albany New York, Everett Washington, Utah, Wisconsin, Georgia, Texas, Idaho, Michigan, New Mexico, New York, Nebraska, Iowa, Washington, Kentucky, Florida, Ohio, Arizona, Vancouver Washington, Owensboro Kentucky, Yonkers New York, Iowa City Iowa, Akron Ohio, Tacoma Washington, Rochester New York, Covington Kentucky, Rio Rancho New Mexico, Houston Texas, Atlanta Georgia, Fort Worth Texas, New York New York, Bellevue Nebraska, Seattle Washington, Grand Rapids Michigan, St. Petersburg Florida, Orlando Florida, Syracuse New York, Tampa Florida, San Antonio Texas, Augusta Georgia, Savannah Georgia, Columbus Georgia, Idaho Falls Idaho, Austin Texas, Miami Florida, Buffalo New York, Des Moines Iowa, Davenport Iowa, Cincinnati Ohio, Macon Georgia, Orem Utah, Provo Utah, Louisville Kentucky, Dayton Ohio, Omaha Nebraska, Kearney Nebraska, Cedar Rapids Iowa, Roswell New Mexico, Warren Michigan, Madison Wisconsin, Sioux City Iowa, Las Cruces New Mexico, Nampa Idaho, Sterling Heights Michigan, Spokane Washington, Cleveland Ohio, Mesa Arizona, Green Bay Wisconsin, Grand Island Nebraska, Meridian Idaho, Santa Fe New Mexico, Lexington-Fayette Kentucky, Boise Idaho, Salt Lake City Utah, Ann Arbor Michigan, Detroit Michigan, Bellevue Washington, Phoenix Arizona, Los Angeles California, San Francisco California, San Jose California, Oakland California, Sacramento California, Fresno California, San Diego California, Layton Utah, Racine Wisconsin, Jacksonville Florida, Lincoln Nebraska, Bowling Green Kentucky, Chandler Arizona, Columbus Ohio, Caldwell Idaho, Tucson Arizona, Milwaukee Wisconsin, Dallas Texas, Albuquerque New Mexico, Scottsdale Arizona, Kenosha Wisconsin, West Valley City Utah 05/29/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs