Care Review Clinician, Inpatient Review (RN) (Work EST Time)
Molina Healthcare Warren, Michigan; Cincinnati, Ohio; Madison, Wisconsin; Layton, Utah; Cleveland, Ohio; Wisconsin; Washington; Atlanta, Georgia; Orlando, Florida; Dallas, Texas; Meridian, Idaho; Mesa, Arizona; Sterling Heights, Michigan; Idaho; West Valley City, Utah; Idaho Falls, Idaho; Provo, Utah; Tucson, Arizona; San Antonio, Texas; Kentucky; Bellevue, Washington; Miami, Florida; Fort Worth, Texas; Columbus, Ohio; Grand Rapids, Michigan; Dayton, Ohio; Nampa, Idaho; St. Petersburg, Florida; New York; Georgia; Nebraska; Houston, Texas; Bellevue, Nebraska; Yonkers, New York; Macon, Georgia; Kearney, Nebraska; Rochester, New York; Salt Lake City, Utah; Bowling Green, Kentucky; Phoenix, Arizona; Davenport, Iowa; Covington, Kentucky; Green Bay, Wisconsin; Michigan; Des Moines, Iowa; Roswell, New Mexico; Tampa, Florida; Las Cruces, New Mexico; Buffalo, New York; Lexington-Fayette, Kentucky; Omaha, Nebraska; Racine, Wisconsin; Iowa City, Iowa; Akron, Ohio; Ohio; Spokane, Washington; Everett, Washington; Grand Island, Nebraska; Milwaukee, Wisconsin; Vancouver, Washington; Scottsdale, Arizona; Cedar Rapids, Iowa; Louisville, Kentucky; Columbus, Georgia; Chandler, Arizona; Kenosha, Wisconsin; Syracuse, New York; Orem, Utah; Santa Fe, New Mexico; Albuquerque, New Mexico; Lincoln, Nebraska; Sioux City, Iowa; Florida; Utah; Texas; Boise, Idaho; New Mexico; Iowa; Albany, New York; Austin, Texas; Caldwell, Idaho; Ann Arbor, Michigan; Jacksonville, Florida; Tacoma, Washington; Owensboro, Kentucky; Savannah, Georgia; Augusta, Georgia; Detroit, Michigan; Rio Rancho, New Mexico Job ID 2032301JOB 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- RN Care Manager - Telephonic Lexington-Fayette Kentucky, Covington Kentucky, Louisville Kentucky 06/20/2025
- Specialist, Appeals & Grievances (Remote) Rio Rancho New Mexico, Cleveland Ohio, Augusta Georgia, Bellevue Washington, Washington, Idaho, Florida, Santa Fe New Mexico, Salt Lake City Utah, Buffalo New York, Lexington-Fayette Kentucky, Dallas Texas, Meridian Idaho, Chandler Arizona, Kenosha Wisconsin, Milwaukee Wisconsin, Fort Worth Texas, Kearney Nebraska, Orlando Florida, Detroit Michigan, Houston Texas, Iowa, Wisconsin, Scottsdale Arizona, Lincoln Nebraska, Dayton Ohio, Jacksonville Florida, Louisville Kentucky, Columbus Ohio, San Antonio Texas, Albany New York, Rochester New York, Miami Florida, Boise Idaho, Savannah Georgia, Cincinnati Ohio, Syracuse New York, Las Cruces New Mexico, Mesa Arizona, Des Moines Iowa, Spokane Washington, Atlanta Georgia, Nebraska, New Mexico, Madison Wisconsin, Texas, Ohio, Provo Utah, Nampa Idaho, Covington Kentucky, Akron Ohio, Yonkers New York, Bellevue Nebraska, Caldwell Idaho, Tampa Florida, Georgia, Grand Island Nebraska, Omaha Nebraska, Sioux City Iowa, Layton Utah, Austin Texas, West Valley City Utah, Albuquerque New Mexico, Vancouver Washington, Racine Wisconsin, Iowa City Iowa, Phoenix Arizona, Orem Utah, New York, Idaho Falls Idaho, Davenport Iowa, Ann Arbor Michigan, Columbus Georgia, Bowling Green Kentucky, Tucson Arizona, Roswell New Mexico, Cedar Rapids Iowa, Everett Washington, Owensboro Kentucky, Michigan, Kentucky, Grand Rapids Michigan, Sterling Heights Michigan, Warren Michigan, Utah, Macon Georgia, Tacoma Washington, Green Bay Wisconsin, St. Petersburg Florida 06/20/2025
- Care Manager: New Mexico Deming New Mexico, Las Cruces New Mexico, Roswell New Mexico, Albuquerque New Mexico, Santa Fe New Mexico, Rio Rancho New Mexico 05/28/2025
- Medical Director (Marketplace) Seattle Washington, Arizona, Everett Washington, Albany New York, Idaho, Iowa, Nebraska, Washington, Texas, Wisconsin, Utah, New Mexico, New York, Ohio, Kentucky, Georgia, Michigan, Florida, Mesa Arizona, Tucson Arizona, Dallas Texas, Ann Arbor Michigan, Cleveland Ohio, Columbus Georgia, Atlanta Georgia, Madison Wisconsin, Caldwell Idaho, Grand Rapids Michigan, Warren Michigan, Syracuse New York, Louisville Kentucky, Davenport Iowa, Idaho Falls Idaho, Santa Fe New Mexico, Albuquerque New Mexico, Tacoma Washington, Vancouver Washington, Omaha Nebraska, Chandler Arizona, Scottsdale Arizona, Austin Texas, San Antonio Texas, Salt Lake City Utah, Akron Ohio, Augusta Georgia, Miami Florida, Lexington-Fayette Kentucky, Nampa Idaho, Las Cruces New Mexico, Rio Rancho New Mexico, Orem Utah, Cedar Rapids Iowa, Savannah Georgia, Boise Idaho, St. Petersburg Florida, Lincoln Nebraska, Des Moines Iowa, Layton Utah, Provo Utah, Racine Wisconsin, Milwaukee Wisconsin, Yonkers New York, Kearney Nebraska, Grand Island Nebraska, Iowa City Iowa, Fort Worth Texas, Roswell New Mexico, Cincinnati Ohio, Green Bay Wisconsin, Bellevue Washington, Jacksonville Florida, Tampa Florida, Orlando Florida, Rochester New York, New York New York, Owensboro Kentucky, Covington Kentucky, Sioux City Iowa, Houston Texas, Macon Georgia, Kenosha Wisconsin, Spokane Washington, Bowling Green Kentucky, Bellevue Nebraska, Meridian Idaho, Phoenix Arizona, West Valley City Utah, Dayton Ohio, Columbus Ohio, Sterling Heights Michigan, Detroit Michigan, Buffalo New York 06/04/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs