Care Review Clinician, Inpatient Review (RN)
Molina Healthcare Albany, New York; Everett, Washington; Kentucky; Wisconsin; New York; Michigan; Ohio; Georgia; Florida; Nebraska; Texas; Iowa; Utah; Washington; Idaho; New Mexico; Nampa, Idaho; Idaho Falls, Idaho; Boise, Idaho; Albuquerque, New Mexico; Las Cruces, New Mexico; Rio Rancho, New Mexico; Warren, Michigan; Bellevue, Washington; St. Petersburg, Florida; Owensboro, Kentucky; Lexington-Fayette, Kentucky; Louisville, Kentucky; Lincoln, Nebraska; Dayton, Ohio; Milwaukee, Wisconsin; Caldwell, Idaho; Austin, Texas; San Antonio, Texas; Ann Arbor, Michigan; Spokane, Washington; Miami, Florida; Davenport, Iowa; Columbus, Georgia; Atlanta, Georgia; Madison, Wisconsin; Dallas, Texas; Grand Rapids, Michigan; Tacoma, Washington; Buffalo, New York; Cedar Rapids, Iowa; Cleveland, Ohio; Cincinnati, Ohio; Columbus, Ohio; Meridian, Idaho; Kenosha, Wisconsin; Tucson, Arizona; Scottsdale, Arizona; Orem, Utah; Racine, Wisconsin; Chandler, Arizona; Mesa, Arizona; Roswell, New Mexico; Detroit, Michigan; Seattle, Washington; Tampa, Florida; Syracuse, New York; Covington, Kentucky; Grand Island, Nebraska; Akron, Ohio; Savannah, Georgia; Phoenix, Arizona; Fort Worth, Texas; Santa Fe, New Mexico; West Valley City, Utah; Layton, Utah; Orlando, Florida; Rochester, New York; Yonkers, New York; Omaha, Nebraska; Kearney, Nebraska; Iowa City, Iowa; Des Moines, Iowa; Augusta, Georgia; Macon, Georgia; Houston, Texas; Provo, Utah; Vancouver, Washington; Sterling Heights, Michigan; Jacksonville, Florida; New York, New York; Bowling Green, Kentucky; Green Bay, Wisconsin; Salt Lake City, Utah; Bellevue, Nebraska; Sioux City, Iowa Job ID 2031162JOB 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: $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: 04/10/2025ABOUT OUR LOCATION
View Map- Sr Auditor, Compliance Everett Washington, Albany New York, Long Beach California, Nebraska, Orem Utah, Idaho Falls Idaho, Las Cruces New Mexico, Grand Rapids Michigan, Dayton Ohio, Seattle Washington, Milwaukee Wisconsin, West Valley City Utah, Tucson Arizona, Florida, Georgia, Tacoma Washington, Racine Wisconsin, Iowa City Iowa, Akron Ohio, Jacksonville Florida, Houston Texas, Bellevue Nebraska, Boise Idaho, Columbus Georgia, Orlando Florida, Wisconsin, Ann Arbor Michigan, Santa Fe New Mexico, Grand Island Nebraska, Salt Lake City Utah, Lexington-Fayette Kentucky, Louisville Kentucky, Provo Utah, Spokane Washington, Caldwell Idaho, Sioux City Iowa, Cedar Rapids Iowa, Atlanta Georgia, Phoenix Arizona, Green Bay Wisconsin, Davenport Iowa, Albuquerque New Mexico, Chandler Arizona, Cincinnati Ohio, New York New York, Bellevue Washington, Nampa Idaho, Utah, Texas, Kentucky, Madison Wisconsin, Sterling Heights Michigan, Tampa Florida, Augusta Georgia, Yonkers New York, Washington, Iowa, Ohio, New Mexico, Cleveland Ohio, Syracuse New York, Buffalo New York, Warren Michigan, Kenosha Wisconsin, Rio Rancho New Mexico, Vancouver Washington, Scottsdale Arizona, Savannah Georgia, Lincoln Nebraska, Columbus Ohio, Roswell New Mexico, Kearney Nebraska, Miami Florida, Idaho, Michigan, Covington Kentucky, Macon Georgia, Layton Utah, Mesa Arizona, Fort Worth Texas, Rochester New York, San Antonio Texas, Detroit Michigan, St. Petersburg Florida, Omaha Nebraska, Bowling Green Kentucky, Meridian Idaho, Dallas Texas, Des Moines Iowa, Austin Texas, Owensboro Kentucky, New York 04/18/2025
- Rep, Customer Experience - Bilingual Spanish Preferred (Remote in WA) - PST Shift Racine Wisconsin, Layton Utah, Boise Idaho, Ann Arbor Michigan, Scottsdale Arizona, Warren Michigan, Milwaukee Wisconsin, Madison Wisconsin, Mesa Arizona, Fort Worth Texas, Iowa, Ohio, Grand Rapids Michigan, Yonkers New York, Green Bay Wisconsin, Albany New York, Everett Washington, Bowling Green Kentucky, Sterling Heights Michigan, San Antonio Texas, Syracuse New York, Nampa Idaho, Rochester New York, Texas, Orlando Florida, Macon Georgia, Bellevue Nebraska, Columbus Ohio, Caldwell Idaho, Lincoln Nebraska, Houston Texas, Davenport Iowa, Grand Island Nebraska, Dayton Ohio, Chandler Arizona, Provo Utah, Vancouver Washington, Bellevue Washington, New Mexico, Lexington-Fayette Kentucky, Akron Ohio, Albuquerque New Mexico, Sioux City Iowa, Michigan, Orem Utah, Atlanta Georgia, Dallas Texas, Kenosha Wisconsin, Roswell New Mexico, Iowa City Iowa, Cleveland Ohio, Rio Rancho New Mexico, Nebraska, Austin Texas, Kearney Nebraska, New York, Salt Lake City Utah, Tucson Arizona, Augusta Georgia, Tampa Florida, Georgia, Louisville Kentucky, Miami Florida, Idaho Falls Idaho, Las Cruces New Mexico, Kentucky, Cincinnati Ohio, New York New York, St. Petersburg Florida, Columbus Georgia, Buffalo New York, Savannah Georgia, Idaho, Detroit Michigan, West Valley City Utah, Omaha Nebraska, Jacksonville Florida, Phoenix Arizona, Florida, Wisconsin, Santa Fe New Mexico, Arizona, Covington Kentucky, Des Moines Iowa, Cedar Rapids Iowa, Meridian Idaho, Owensboro Kentucky, Utah, Tacoma Washington, Spokane Washington, Seattle Washington 04/16/2025
- Rep, Customer Experience - Bilingual Spanish Preferred (Remote in Nevada) - PST Shift Albany New York, St. Petersburg Florida, Idaho, Green Bay Wisconsin, Bellevue Nebraska, New Mexico, Iowa, Buffalo New York, Tacoma Washington, Racine Wisconsin, Savannah Georgia, Phoenix Arizona, Ohio, Lexington-Fayette Kentucky, Detroit Michigan, Sioux City Iowa, Iowa City Iowa, Grand Rapids Michigan, Nampa Idaho, Vancouver Washington, Utah, Sterling Heights Michigan, Salt Lake City Utah, Orlando Florida, Everett Washington, Cleveland Ohio, Columbus Georgia, Austin Texas, Ann Arbor Michigan, San Antonio Texas, West Valley City Utah, Boise Idaho, Florida, Orem Utah, Miami Florida, Kentucky, Scottsdale Arizona, Bellevue Washington, Caldwell Idaho, Wisconsin, Atlanta Georgia, Covington Kentucky, Nebraska, Yonkers New York, Mesa Arizona, Akron Ohio, Provo Utah, Rio Rancho New Mexico, New York, Idaho Falls Idaho, New York New York, Las Cruces New Mexico, Tampa Florida, Omaha Nebraska, Spokane Washington, Albuquerque New Mexico, Jacksonville Florida, Cincinnati Ohio, Roswell New Mexico, Grand Island Nebraska, Syracuse New York, Seattle Washington, Cedar Rapids Iowa, Kearney Nebraska, Louisville Kentucky, Dallas Texas, Arizona, Rochester New York, Milwaukee Wisconsin, Meridian Idaho, Michigan, Warren Michigan, Chandler Arizona, Georgia, Texas, Davenport Iowa, Dayton Ohio, Fort Worth Texas, Columbus Ohio, Santa Fe New Mexico, Madison Wisconsin, Des Moines Iowa, Augusta Georgia, Washington, Kenosha Wisconsin, Owensboro Kentucky, Layton Utah, Bowling Green Kentucky, Macon Georgia, Lincoln Nebraska, Tucson Arizona, Houston Texas 04/16/2025
- Care Connections Representative - (Must be Bilingual (Chinese, Vietnamese, Korean or Spanish) 10:30 - 7PM PST Hours Everett Washington, Albany New York, Miami Florida, Austin Texas, New Mexico, Savannah Georgia, Davenport Iowa, Dallas Texas, Racine Wisconsin, Tampa Florida, Ohio, Roswell New Mexico, Bowling Green Kentucky, Salt Lake City Utah, Lexington-Fayette Kentucky, Macon Georgia, Scottsdale Arizona, Spokane Washington, Tacoma Washington, Kenosha Wisconsin, Nebraska, Idaho, Tucson Arizona, Rochester New York, Akron Ohio, Jacksonville Florida, Layton Utah, Detroit Michigan, Yonkers New York, Bellevue Nebraska, Lincoln Nebraska, Meridian Idaho, Madison Wisconsin, Atlanta Georgia, Provo Utah, Milwaukee Wisconsin, Owensboro Kentucky, Boise Idaho, West Valley City Utah, Nampa Idaho, Washington, Georgia, Rio Rancho New Mexico, Dayton Ohio, Syracuse New York, Las Cruces New Mexico, New York New York, Iowa, Seattle Washington, Michigan, Texas, Louisville Kentucky, Des Moines Iowa, Iowa City Iowa, Idaho Falls Idaho, Vancouver Washington, Houston Texas, Sioux City Iowa, Covington Kentucky, Omaha Nebraska, Ann Arbor Michigan, Chandler Arizona, Kearney Nebraska, Augusta Georgia, Orem Utah, Buffalo New York, Sterling Heights Michigan, Orlando Florida, Bellevue Washington, Kentucky, Utah, St. Petersburg Florida, Warren Michigan, Mesa Arizona, Wisconsin, Cedar Rapids Iowa, Phoenix Arizona, Cleveland Ohio, Santa Fe New Mexico, Grand Island Nebraska, Caldwell Idaho, Green Bay Wisconsin, New York, Cincinnati Ohio, Florida, Fort Worth Texas, Columbus Ohio, Columbus Georgia, San Antonio Texas, Albuquerque New Mexico, Grand Rapids Michigan 04/15/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs