Care Review Clinician, Inpatient Review (RN)
Molina Healthcare Layton, Utah; San Antonio, Texas; Cedar Rapids, Iowa; Santa Fe, New Mexico; Syracuse, New York; Las Cruces, New Mexico; Salt Lake City, Utah; Kentucky; Utah; Tampa, Florida; Augusta, Georgia; Atlanta, Georgia; Yonkers, New York; Grand Island, Nebraska; Milwaukee, Wisconsin; Racine, Wisconsin; Jacksonville, Florida; Phoenix, Arizona; Rio Rancho, New Mexico; Bellevue, Washington; Iowa; Lincoln, Nebraska; Green Bay, Wisconsin; Warren, Michigan; Provo, Utah; Dayton, Ohio; Bowling Green, Kentucky; Louisville, Kentucky; Albany, New York; Austin, Texas; Albuquerque, New Mexico; Nebraska; Covington, Kentucky; Rochester, New York; Ann Arbor, Michigan; Des Moines, Iowa; Tucson, Arizona; Roswell, New Mexico; Dallas, Texas; West Valley City, Utah; Wisconsin; Savannah, Georgia; Tacoma, Washington; Miami, Florida; Scottsdale, Arizona; Akron, Ohio; Columbus, Georgia; Bellevue, Nebraska; Owensboro, Kentucky; Orem, Utah; Cleveland, Ohio; Nampa, Idaho; Meridian, Idaho; Orlando, Florida; Macon, Georgia; Idaho Falls, Idaho; Vancouver, Washington; Columbus, Ohio; Boise, Idaho; New York; Chandler, Arizona; Mesa, Arizona; Cincinnati, Ohio; Florida; Lexington-Fayette, Kentucky; Sterling Heights, Michigan; Everett, Washington; Madison, Wisconsin; Washington; Idaho; Ohio; Davenport, Iowa; Kenosha, Wisconsin; Georgia; Detroit, Michigan; Houston, Texas; Iowa City, Iowa; Fort Worth, Texas; Kearney, Nebraska; Caldwell, Idaho; Grand Rapids, Michigan; Buffalo, New York; Texas; Michigan; New Mexico; Sioux City, Iowa; St. Petersburg, Florida; Omaha, Nebraska; Spokane, Washington Job ID 2032143JOB 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.
State Specific Requirements:
IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment
Preferred Education
Bachelor's Degree in Nursing
Preferred Experience
Recent hospital experience in ICU, Medical, or ER unit.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
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: 06/20/2025ABOUT OUR LOCATION
View Map- Associate Actuarial Analyst - REMOTE Grand Island Nebraska, Phoenix Arizona, Orem Utah, Provo Utah, Salt Lake City Utah, Bellevue Washington, Sterling Heights Michigan, Mesa Arizona, Savannah Georgia, Michigan, Akron Ohio, Layton Utah, Rio Rancho New Mexico, Kearney Nebraska, Grand Rapids Michigan, Spokane Washington, Albany New York, Green Bay Wisconsin, Santa Fe New Mexico, Dayton Ohio, Ohio, Orlando Florida, Louisville Kentucky, Des Moines Iowa, Racine Wisconsin, Vancouver Washington, Sioux City Iowa, Covington Kentucky, Bellevue Nebraska, Meridian Idaho, Albuquerque New Mexico, Syracuse New York, Georgia, Yonkers New York, Fort Worth Texas, Columbus Georgia, Houston Texas, Dallas Texas, Warren Michigan, Chandler Arizona, Tampa Florida, Tacoma Washington, Kentucky, New York, Iowa, Cedar Rapids Iowa, Owensboro Kentucky, West Valley City Utah, Kenosha Wisconsin, Wisconsin, Jacksonville Florida, San Antonio Texas, Texas, Columbus Ohio, Las Cruces New Mexico, Buffalo New York, Everett Washington, Lincoln Nebraska, Austin Texas, Augusta Georgia, St. Petersburg Florida, New Mexico, Nebraska, Iowa City Iowa, Rochester New York, Cincinnati Ohio, Madison Wisconsin, Davenport Iowa, Scottsdale Arizona, Nampa Idaho, Lexington-Fayette Kentucky, Caldwell Idaho, Cleveland Ohio, Washington, Utah, Idaho, Miami Florida, Macon Georgia, Tucson Arizona, Idaho Falls Idaho, Roswell New Mexico, Boise Idaho, Omaha Nebraska, Bowling Green Kentucky, Atlanta Georgia, Detroit Michigan, Florida, Ann Arbor Michigan, Milwaukee Wisconsin 06/13/2025
- Care Manager: New Mexico Deming New Mexico, Las Cruces New Mexico, Roswell New Mexico, Santa Fe New Mexico, Rio Rancho New Mexico, Albuquerque New Mexico 05/28/2025
- Director, Network Strategy (Marketplace) - REMOTE Albany New York, Everett Washington, Utah, Wisconsin, New York, Michigan, Ohio, Kentucky, Texas, Washington, New Mexico, Idaho, Florida, Nebraska, Georgia, Iowa, Albuquerque New Mexico, Tacoma Washington, Spokane Washington, Orlando Florida, Covington Kentucky, Louisville Kentucky, Dayton Ohio, Columbus Georgia, Chandler Arizona, Mesa Arizona, West Valley City Utah, Seattle Washington, Sioux City Iowa, Davenport Iowa, Cedar Rapids Iowa, Augusta Georgia, Racine Wisconsin, Caldwell Idaho, Phoenix Arizona, San Antonio Texas, Fort Worth Texas, Salt Lake City Utah, Syracuse New York, New York New York, Owensboro Kentucky, Lexington-Fayette Kentucky, Yonkers New York, Savannah Georgia, Houston Texas, Rio Rancho New Mexico, Roswell New Mexico, Layton Utah, Vancouver Washington, Buffalo New York, Lincoln Nebraska, Grand Island Nebraska, Cleveland Ohio, Atlanta Georgia, Green Bay Wisconsin, Kenosha Wisconsin, Tucson Arizona, Austin Texas, Santa Fe New Mexico, Las Cruces New Mexico, Bellevue Washington, Columbus Ohio, Grand Rapids Michigan, Meridian Idaho, Idaho Falls Idaho, Warren Michigan, Detroit Michigan, St. Petersburg Florida, Tampa Florida, Des Moines Iowa, Madison Wisconsin, Milwaukee Wisconsin, Ann Arbor Michigan, Sterling Heights Michigan, Dallas Texas, Orem Utah, Kearney Nebraska, Akron Ohio, Macon Georgia, Provo Utah, Jacksonville Florida, Miami Florida, Rochester New York, Bowling Green Kentucky, Bellevue Nebraska, Omaha Nebraska, Iowa City Iowa, Cincinnati Ohio, Boise Idaho, Nampa Idaho, Scottsdale Arizona 06/06/2025
- Manager, Medical Economics (Pop Health/Clinical Analytics) - REMOTE Albany New York, Everett Washington, Florida, Kentucky, Nebraska, Iowa, Georgia, Michigan, Texas, Utah, Idaho, New York, Ohio, Washington, New Mexico, Wisconsin, Rio Rancho New Mexico, Salt Lake City Utah, Ann Arbor Michigan, Grand Rapids Michigan, Miami Florida, Syracuse New York, Yonkers New York, Covington Kentucky, Des Moines Iowa, Columbus Ohio, Layton Utah, Warren Michigan, Spokane Washington, Buffalo New York, Rochester New York, Iowa City Iowa, Akron Ohio, Columbus Georgia, Green Bay Wisconsin, Jacksonville Florida, New York New York, Bowling Green Kentucky, Cleveland Ohio, Caldwell Idaho, Mesa Arizona, Austin Texas, Dallas Texas, Fort Worth Texas, Houston Texas, Sterling Heights Michigan, Detroit Michigan, Seattle Washington, Kearney Nebraska, Davenport Iowa, Cincinnati Ohio, Atlanta Georgia, Kenosha Wisconsin, Scottsdale Arizona, Albuquerque New Mexico, Tacoma Washington, Omaha Nebraska, Cedar Rapids Iowa, Macon Georgia, Madison Wisconsin, Meridian Idaho, Phoenix Arizona, Chandler Arizona, Tucson Arizona, San Antonio Texas, Las Cruces New Mexico, Orem Utah, Tampa Florida, Owensboro Kentucky, Lexington-Fayette Kentucky, Louisville Kentucky, Sioux City Iowa, Racine Wisconsin, Nampa Idaho, Idaho Falls Idaho, Santa Fe New Mexico, West Valley City Utah, Provo Utah, Orlando Florida, Dayton Ohio, Augusta Georgia, Milwaukee Wisconsin, Boise Idaho, Roswell New Mexico, Bellevue Washington, Vancouver Washington, St. Petersburg Florida, Bellevue Nebraska, Lincoln Nebraska, Grand Island Nebraska, Savannah Georgia 04/15/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs