ATTENTION JOB SEEKERS AND MOLINA APPLICANTS: FRAUD ALERT
Be aware that third parties posing as Molina Healthcare may be soliciting money from job seekers and extending offers to candidates who have not interviewed. Molina does not engage in these type of practices. If you have received an offer and have not been engaging with Molina Healthcare in an interview process, reach out to erc@molinahealthcare.com to validate the legitimacy of your offer. Please note that Molina has reported this activity to the appropriate law enforcement agencies for further investigation. If you feel you’ve been victimized, please report it to local law enforcement.
Medical Claim Review LVN/LPN (CA LVN Required)
Molina Healthcare Sioux City, Iowa; Akron, Ohio; Atlanta, Georgia; Kearney, Nebraska; Layton, Utah; Houston, Texas; Madison, Wisconsin; Spokane, Washington; Davenport, Iowa; Ohio; Des Moines, Iowa; Tacoma, Washington; Roswell, New Mexico; Buffalo, New York; Bowling Green, Kentucky; Utah; Florida; Georgia; Mesa, Arizona; Salt Lake City, Utah; Owensboro, Kentucky; Sterling Heights, Michigan; Grand Rapids, Michigan; Green Bay, Wisconsin; Detroit, Michigan; Albuquerque, New Mexico; Cleveland, Ohio; Provo, Utah; New York; Jacksonville, Florida; Austin, Texas; Wisconsin; Kenosha, Wisconsin; West Valley City, Utah; Fort Worth, Texas; Lincoln, Nebraska; Las Cruces, New Mexico; Albany, New York; Boise, Idaho; Idaho Falls, Idaho; Syracuse, New York; Macon, Georgia; Lexington-Fayette, Kentucky; New Mexico; Bellevue, Washington; Meridian, Idaho; Columbus, Georgia; Scottsdale, Arizona; Omaha, Nebraska; Iowa; Orlando, Florida; Caldwell, Idaho; Washington; Ann Arbor, Michigan; Dayton, Ohio; Grand Island, Nebraska; Texas; Cincinnati, Ohio; Columbus, Ohio; Arizona; Louisville, Kentucky; Savannah, Georgia; Augusta, Georgia; Dallas, Texas; Bellevue, Nebraska; Tampa, Florida; Phoenix, Arizona; Vancouver, Washington; Miami, Florida; Racine, Wisconsin; Tucson, Arizona; Iowa City, Iowa; Rio Rancho, New Mexico; Kentucky; Milwaukee, Wisconsin; Warren, Michigan; Nampa, Idaho; Nebraska; St. Petersburg, Florida; Covington, Kentucky; Orem, Utah; Idaho; San Antonio, Texas; Everett, Washington; Rochester, New York; Cedar Rapids, Iowa; Santa Fe, New Mexico; Yonkers, New York; Michigan; Chandler, Arizona Job ID 2033531Job Summary
Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.
Knowledge/Skills/Abilities
• Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing. • Evaluates medical records and/or medical notes providing clinical expertise on coding accuracy.
• Reviews provider reconsideration requests related to claim edits and validation outcomes.
• Identifies and reports quality of care issues.
• Identifies and refers members with special needs to the appropriate Molina Healthcare program per policy/protocol.
• Helps with the development and implementation of proactive approaches to improve and standardize overall retrospective claims review.
• Ensures core system is updated correctly to process claim..
Job Qualifications
Required Education
Licensed Vocational Nurse / Licensed Practical Nurse.
Required Experience
Minimum three years clinical nursing experience.
Minimum one year Utilization Review and/or Medical
Claims Review.
Required License, Certification, Association
Active, unrestricted State Licensed Vocational Nurse (LVN) license in good standing.
Preferred Education
Registered Nurse.
Bachelor's Degree in Nursing or Health Related Field
Master's degree in Nursing or Health Related Field.
Preferred Experience
Nursing experience in Critical Care, Emergency Medicine, Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience.
Preferred License, Certification, Association
Registered Nursing license in good standing.
Certified Clinical Coder, Certified Medical Audit Specialists (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other healthcare certification.
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: $24 - $56.17 / 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 09/10/2025Job Alerts
Sign up to receive automatic notices when jobs that match your interests are posted.
OPEN FORM