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Care Review Clinician, PA (RN)
Molina Healthcare St. Petersburg, Florida; Cleveland, Ohio; Davenport, Iowa; Dayton, Ohio; Salt Lake City, Utah; Utah; Miami, Florida; Racine, Wisconsin; Chandler, Arizona; Des Moines, Iowa; Albany, New York; Roswell, New Mexico; Idaho Falls, Idaho; Meridian, Idaho; Spokane, Washington; Owensboro, Kentucky; Cincinnati, Ohio; Bowling Green, Kentucky; Green Bay, Wisconsin; Layton, Utah; Boise, Idaho; Covington, Kentucky; Fort Worth, Texas; Houston, Texas; Atlanta, Georgia; Sterling Heights, Michigan; West Valley City, Utah; Macon, Georgia; Iowa City, Iowa; Austin, Texas; Michigan; Orlando, Florida; Georgia; Sioux City, Iowa; Warren, Michigan; Caldwell, Idaho; Louisville, Kentucky; Bellevue, Nebraska; Dallas, Texas; New Mexico; Akron, Ohio; Rochester, New York; Albuquerque, New Mexico; New York; Santa Fe, New Mexico; Savannah, Georgia; Columbus, Georgia; Lincoln, Nebraska; Yonkers, New York; Jacksonville, Florida; Kenosha, Wisconsin; Iowa; Omaha, Nebraska; Kentucky; Nebraska; Lexington-Fayette, Kentucky; San Antonio, Texas; Grand Island, Nebraska; Mesa, Arizona; Grand Rapids, Michigan; Rio Rancho, New Mexico; Florida; Ohio; Tampa, Florida; Tucson, Arizona; Cedar Rapids, Iowa; Madison, Wisconsin; Nampa, Idaho; Provo, Utah; Washington; Scottsdale, Arizona; Milwaukee, Wisconsin; Augusta, Georgia; Buffalo, New York; Las Cruces, New Mexico; Syracuse, New York; Wisconsin; Kearney, Nebraska; Orem, Utah; Detroit, Michigan; Everett, Washington; Texas; Tacoma, Washington; Ann Arbor, Michigan; Columbus, Ohio; Phoenix, Arizona; Vancouver, Washington; Idaho; Bellevue, Washington Job ID 2032895JOB DESCRIPTION
This position will support the Arizona state Plan. We are seeking a candidate with an Arizona RN licensure. The ideal candidate will have experience with UM and prior authorization, within both Physical Health and Behavioral Health. Candidates with a Behavioral Health background are highly preferred. Further details to be discussed during our interview process.
Remote position - Home office with internet connectivity of high speed required.
Work hours: Monday - Friday 8:00am- 5:00pm Arizona time with some weekends and holidays.
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 - $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 08/04/2025Job Alerts
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