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Care Review Clinician (RN)

Passport Health Plan by Molina Healthcare

Kentucky; Cedar Rapids, Iowa; Grand Island, Nebraska; South Carolina; Yonkers, New York; Chandler, Arizona; Lincoln, Nebraska; Ohio; Tucson, Arizona; Vancouver, Washington; Miami, Florida; Grand Rapids, Michigan; Caldwell, Idaho; Everett, Washington; Atlanta, Georgia; Mesa, Arizona; Des Moines, Iowa; Phoenix, Arizona; Rio Rancho, New Mexico; Augusta, Georgia; Utah; Albany, New York; Cleveland, Ohio; Columbia, South Carolina; Hattiesburg, Mississippi; Tacoma, Washington; Bellevue, Nebraska; Syracuse, New York; Rock Hill, South Carolina; Boise, Idaho; Jackson, Mississippi; Green Bay, Wisconsin; Houston, Texas; Las Cruces, New Mexico; Columbus, Georgia; Idaho; Orem, Utah; Kearney, Nebraska; San Antonio, Texas; Arizona; Dallas, Texas; Tampa, Florida; Gulfport, Mississippi; Michigan; Sioux City, Iowa; Milwaukee, Wisconsin; Savannah, Georgia; West Valley City, Utah; North Charleston, South Carolina; Santa Fe, New Mexico; Southaven, Mississippi; Dayton, Ohio; Roswell, New Mexico; Buffalo, New York; Jacksonville, Florida; Salt Lake City, Utah; Meridian, Idaho; Rochester, New York; Wisconsin; Nebraska; Ann Arbor, Michigan; Iowa; Georgia; Idaho Falls, Idaho; Texas; Columbus, Ohio; New York; Kenosha, Wisconsin; Provo, Utah; Biloxi, Mississippi; New Mexico; Racine, Wisconsin; Austin, Texas; Spokane, Washington; Albuquerque, New Mexico; Nampa, Idaho; Orlando, Florida; Davenport, Iowa; Iowa City, Iowa; Florida; Layton, Utah; Macon, Georgia; Madison, Wisconsin; Washington; Cincinnati, Ohio; Detroit, Michigan; Mt. Pleasant, South Carolina; Omaha, Nebraska; Scottsdale, Arizona; Charleston, South Carolina; Akron, Ohio; Warren, Michigan; Fort Worth, Texas; Mississippi; St. Petersburg, Florida; Sterling Heights, Michigan; Lexington-Fayette, Kentucky; Owensboro, Kentucky; Louisville, Kentucky; Covington, Kentucky; Bowling Green, Kentucky

Job ID 2035517

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Overview

Passport Health Plan by Molina Healthcare has a mission to provide quality health care to those who need it, no matter their circumstances. Today, Molina health plans serve 3,331,000 members across the country through government-funded programs. Each day, we work to earn the trust our partners and members put in us, so they can lean on Molina. Together, Passport Health Plan and Molina share a commitment to improving the health and quality of life of our members across the Commonwealth of Kentucky.

Experienced professionals and new grads are encouraged to apply.

Full Time
Level: Mid-Level
Travel: Yes

Success Profile

What makes you successful at Passport Health Plan by Molina Healthcare? Check out the traits we’re looking for and see if you're the right fit!

Compassionate
Consultive
Patient
Problem-Solver
Sincere
Relationship Expertise

BENEFITS

Insurance

Medical · Dental · Vision Group & Voluntary Life Insurance Aflac · Pet Health · Identity Theft Auto & Home Insurance
Savings

Flexible Spending Accounts 401K · Roth 401K Employee Stock Purchase Plan
Career Growth

Continuing Education Units Education Reimbursement
Time Off

Paid Time Off Volunteer Time Off Company Holidays
Additional Benefits

Legal Assistance Plan Employee Assistance & Well Being Programs Employee Perks Platform Rideshare Portal

RESPONSIBILITIES

JOB DESCRIPTION

For this position we are seeking a RN with a current active license for state of KY and or compact licensure

The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and inpatient services for the KY Medicaid behavioral health population. Strong post-acute level of care experience (Nursing Facilities, Acute Inpatient, Rehabilitation, Long Term Acute care hospital, Behavioral Health Facility. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good analytical thought process is important to be successful in this role. Prefer candidates that have experience doing prior authorizations for outpatient services preferrable within Behavioral Health Population.

WORK SCHEDULE: Monday thru Friday 8:00 AM to 5:00 PM EST - Training Schedule (30 to 60 days)

Permanent schedule will require you to work 4 to 5 days a week - with one weekend day required (Saturday, Sunday (either one or both))

This is a Remote position, home office with internet connectivity of high speed required.

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/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 reviews to determine prior authorization/financial responsibility for Molina and its members.
• Processes requests within required timelines.
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
• Requests additional information from members or providers as needed.
• Makes appropriate referrals to other clinical programs.
• Collaborates with multidisciplinary teams to promote the Molina care model.
• Adheres to utilization management (UM) policies and procedures.

Required Qualifications
• At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications
• Certified Professional in Healthcare Management (CPHM).
• Recent hospital experience in an intensive care unit (ICU) or emergency room.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $25.08 - $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 01/13/2026