Care Review Clinician, PA (RN) - Transplant Team - Compact License
Molina Healthcare Everett, Washington; Albany, New York; New York, New York; Seattle, Washington; Austin, Texas; Salt Lake City, Utah; West Valley City, Utah; Spokane, Washington; Jacksonville, Florida; Florida; Augusta, Georgia; Roswell, New Mexico; Davenport, Iowa; Idaho Falls, Idaho; Cincinnati, Ohio; Albuquerque, New Mexico; Wisconsin; Tucson, Arizona; Mesa, Arizona; Warren, Michigan; St. Petersburg, Florida; Atlanta, Georgia; Rochester, New York; Macon, Georgia; Syracuse, New York; New York; Cleveland, Ohio; Dallas, Texas; Houston, Texas; Santa Fe, New Mexico; Grand Island, Nebraska; Layton, Utah; Phoenix, Arizona; Detroit, Michigan; Michigan; Columbus, Georgia; Cedar Rapids, Iowa; Meridian, Idaho; Akron, Ohio; Bowling Green, Kentucky; Madison, Wisconsin; Kenosha, Wisconsin; Orlando, Florida; Yonkers, New York; Iowa; Ohio; San Antonio, Texas; Lincoln, Nebraska; Provo, Utah; Washington; Vancouver, Washington; Grand Rapids, Michigan; Scottsdale, Arizona; Tampa, Florida; Rio Rancho, New Mexico; Iowa City, Iowa; Sioux City, Iowa; Des Moines, Iowa; Boise, Idaho; Louisville, Kentucky; Owensboro, Kentucky; Omaha, Nebraska; Bellevue, Nebraska; Green Bay, Wisconsin; Tacoma, Washington; Bellevue, Washington; Chandler, Arizona; Miami, Florida; New Mexico; Nampa, Idaho; Fort Worth, Texas; Lexington-Fayette, Kentucky; Kearney, Nebraska; Orem, Utah; Ann Arbor, Michigan; Savannah, Georgia; Buffalo, New York; Columbus, Ohio; Caldwell, Idaho; Dayton, Ohio; Las Cruces, New Mexico; Idaho; Covington, Kentucky; Milwaukee, Wisconsin; Utah; Kentucky; Sterling Heights, Michigan; Georgia; Nebraska; Racine, Wisconsin; Texas Job ID 2030653JOB DESCRIPTION
Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior authorization requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants.  Preference will be given to those whose UM experience is within another MCO like Molina; experience with Interqual/MCG guidelines is needed. Excellent computer, multi-tasking skills, and analytical thought processes are vital to be successful in this role. Productivity is important with specific turnaround times that must be met.Â
Preference will be given to candidates who are willing to work PST schedule M - F and there may also be weekend and/or holiday coverage due to business needs.Â
Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note.
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.
- Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Registered Nurse (RN).
Required Experience
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
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 - $61.79 / 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: 03/05/2025ABOUT OUR LOCATION
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