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
View Map- Lead Data Analyst (Medicare Stars) Everett Washington, Albany New York, Idaho Falls Idaho, Kearney Nebraska, Augusta Georgia, Columbus Georgia, Nampa Idaho, Detroit Michigan, Albuquerque New Mexico, Ann Arbor Michigan, Cleveland Ohio, Rio Rancho New Mexico, Dayton Ohio, Washington, Madison Wisconsin, Boise Idaho, Owensboro Kentucky, Michigan, Sterling Heights Michigan, Yonkers New York, Columbus Ohio, Cincinnati Ohio, San Antonio Texas, Salt Lake City Utah, Layton Utah, Bellevue Washington, Phoenix Arizona, Miami Florida, Savannah Georgia, Macon Georgia, St. Petersburg Florida, Meridian Idaho, Warren Michigan, Grand Island Nebraska, Omaha Nebraska, Chandler Arizona, Akron Ohio, Green Bay Wisconsin, Mesa Arizona, Jacksonville Florida, Georgia, Caldwell Idaho, Covington Kentucky, Grand Rapids Michigan, Las Cruces New Mexico, Lincoln Nebraska, Rochester New York, Orem Utah, Provo Utah, Vancouver Washington, Kenosha Wisconsin, Milwaukee Wisconsin, Tampa Florida, Orlando Florida, Idaho, Kentucky, New York, Buffalo New York, New York New York, Austin Texas, Houston Texas, West Valley City Utah, Tucson Arizona, Davenport Iowa, Cedar Rapids Iowa, Bowling Green Kentucky, Nebraska, Santa Fe New Mexico, New Mexico, Fort Worth Texas, Utah, Tacoma Washington, Racine Wisconsin, Wisconsin, Sioux City Iowa, Iowa, Louisville Kentucky, Lexington-Fayette Kentucky, Roswell New Mexico, Syracuse New York, Bellevue Nebraska, Ohio, Texas, Dallas Texas, Spokane Washington, Seattle Washington, Scottsdale Arizona, Florida, Atlanta Georgia, Des Moines Iowa, Iowa City Iowa 03/18/2025
- Principal Data Scientist - Generative AI, Machine Learning, Python, R - Remote Albany New York, Everett Washington, Austin Texas, Bellevue Nebraska, Meridian Idaho, Scottsdale Arizona, Miami Florida, Grand Rapids Michigan, Sterling Heights Michigan, Akron Ohio, Ann Arbor Michigan, Salt Lake City Utah, Orlando Florida, Lexington-Fayette Kentucky, Des Moines Iowa, Lincoln Nebraska, Yonkers New York, Kenosha Wisconsin, Albuquerque New Mexico, Las Cruces New Mexico, Spokane Washington, Vancouver Washington, New York New York, Macon Georgia, Syracuse New York, Columbus Ohio, Boise Idaho, Caldwell Idaho, Green Bay Wisconsin, Augusta Georgia, Iowa City Iowa, Madison Wisconsin, West Valley City Utah, Columbus Georgia, San Antonio Texas, Rio Rancho New Mexico, Provo Utah, Fort Worth Texas, Tampa Florida, Idaho Falls Idaho, Phoenix Arizona, Warren Michigan, Houston Texas, Savannah Georgia, Santa Fe New Mexico, Milwaukee Wisconsin, Tucson Arizona, Roswell New Mexico, Orem Utah, Atlanta Georgia, Mesa Arizona, Cleveland Ohio, Racine Wisconsin, Detroit Michigan, Tacoma Washington, Jacksonville Florida, Seattle Washington, Grand Island Nebraska, Owensboro Kentucky, Nampa Idaho, Kearney Nebraska, Rochester New York, Louisville Kentucky, Cedar Rapids Iowa, Davenport Iowa, Dallas Texas, Sioux City Iowa, Covington Kentucky, Chandler Arizona, Omaha Nebraska, Buffalo New York, Bellevue Washington, Bowling Green Kentucky, Layton Utah, Cincinnati Ohio, Iowa, New Mexico, Utah, Washington, Kentucky, Nebraska, Georgia, Michigan, New York, Ohio, Florida, Idaho, Texas, Wisconsin 11/06/2024
- Rep, Customer Experience Boise Idaho, Ohio, Iowa City Iowa, Bowling Green Kentucky, Sioux City Iowa, Idaho Falls Idaho, Grand Island Nebraska, Meridian Idaho, Caldwell Idaho, Kentucky, Nampa Idaho, Covington Kentucky, Lexington-Fayette Kentucky, Lincoln Nebraska, Cedar Rapids Iowa, Kearney Nebraska, Davenport Iowa, Louisville Kentucky, Owensboro Kentucky, Iowa, Des Moines Iowa, Idaho, Omaha Nebraska 05/14/2025
- Rep, Customer Experience Racine Wisconsin, Akron Ohio, Layton Utah, Kenosha Wisconsin, Utah, Wisconsin, Florida, Houston Texas, Austin Texas, Green Bay Wisconsin, New Mexico, Atlanta Georgia, West Valley City Utah, Phoenix Arizona, Orem Utah, Las Cruces New Mexico, Tampa Florida, Roswell New Mexico, Detroit Michigan, Savannah Georgia, Cleveland Ohio, Tucson Arizona, Georgia, Miami Florida, Provo Utah, San Antonio Texas, Santa Fe New Mexico, Salt Lake City Utah, Chandler Arizona, Fort Worth Texas, Columbus Ohio, Michigan, Scottsdale Arizona, St. Petersburg Florida, Dayton Ohio, Jacksonville Florida, Rio Rancho New Mexico, Ohio, Columbus Georgia, Dallas Texas, Augusta Georgia, Warren Michigan, Mesa Arizona, Ann Arbor Michigan, Albuquerque New Mexico, Grand Rapids Michigan, Sterling Heights Michigan, Cincinnati Ohio, Texas, Macon Georgia, Orlando Florida, Madison Wisconsin, Milwaukee Wisconsin 05/14/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs