Care Review Clinician, PA (RN)
Molina Healthcare Wisconsin; Boise, Idaho; Meridian, Idaho; Idaho Falls, Idaho; Provo, Utah; Cincinnati, Ohio; Kearney, Nebraska; Rochester, New York; Atlanta, Georgia; Michigan; Ohio; Georgia; Spokane, Washington; Santa Fe, New Mexico; Salt Lake City, Utah; Vancouver, Washington; Columbus, Georgia; Houston, Texas; Washington; San Antonio, Texas; Orem, Utah; Green Bay, Wisconsin; St. Petersburg, Florida; Omaha, Nebraska; Davenport, Iowa; Dayton, Ohio; Chandler, Arizona; Mesa, Arizona; Grand Island, Nebraska; Rio Rancho, New Mexico; Idaho; Bellevue, Washington; Savannah, Georgia; Sioux City, Iowa; Grand Rapids, Michigan; Lexington-Fayette, Kentucky; Tampa, Florida; Fort Worth, Texas; Roswell, New Mexico; Detroit, Michigan; Nebraska; Florida; Iowa; Kentucky; Bellevue, Nebraska; Owensboro, Kentucky; Las Cruces, New Mexico; Warren, Michigan; Macon, Georgia; Louisville, Kentucky; Cedar Rapids, Iowa; Texas; Scottsdale, Arizona; Nampa, Idaho; Covington, Kentucky; Cleveland, Ohio; Albuquerque, New Mexico; Ann Arbor, Michigan; Columbus, Ohio; Miami, Florida; Orlando, Florida; Yonkers, New York; Everett, Washington; Albany, New York; Caldwell, Idaho; Akron, Ohio; Bowling Green, Kentucky; Tacoma, Washington; Dallas, Texas; Kenosha, Wisconsin; Milwaukee, Wisconsin; Des Moines, Iowa; Augusta, Georgia; New Mexico; Austin, Texas; Jacksonville, Florida; Layton, Utah; West Valley City, Utah; Lincoln, Nebraska; Phoenix, Arizona; Syracuse, New York; Racine, Wisconsin; Madison, Wisconsin; Buffalo, New York; Iowa City, Iowa; Sterling Heights, Michigan; Tucson, Arizona; Utah; New York Job ID 2032736JOB 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 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.
Preferred Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.Â
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
MULTI STATE / COMPACT LICENSURE
Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI
WORK SCHEDULE: Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.
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: 07/23/2025ABOUT OUR LOCATION
View Map- Care Connections Representative - Must Be Bilingual (Arabic, Russian, French, Armenian, Tagalog, or Korean) 8:30AM - 5PM PST Hours Sterling Heights Michigan, Des Moines Iowa, Orlando Florida, Idaho Falls Idaho, Provo Utah, Spokane Washington, Miami Florida, Utah, New York, Albany New York, Tacoma Washington, Dayton Ohio, Rio Rancho New Mexico, Grand Island Nebraska, Kearney Nebraska, Owensboro Kentucky, Boise Idaho, Omaha Nebraska, Davenport Iowa, Madison Wisconsin, Grand Rapids Michigan, Tampa Florida, Milwaukee Wisconsin, Roswell New Mexico, Bellevue Nebraska, Covington Kentucky, Akron Ohio, Bowling Green Kentucky, Syracuse New York, Las Cruces New Mexico, Macon Georgia, Vancouver Washington, Scottsdale Arizona, Everett Washington, Cedar Rapids Iowa, Wisconsin, San Antonio Texas, Michigan, Nebraska, Santa Fe New Mexico, Salt Lake City Utah, Lexington-Fayette Kentucky, Kenosha Wisconsin, Louisville Kentucky, Columbus Ohio, Columbus Georgia, Florida, Idaho, Washington, Bellevue Washington, West Valley City Utah, Layton Utah, Dallas Texas, Warren Michigan, Mesa Arizona, Cincinnati Ohio, Fort Worth Texas, Detroit Michigan, Houston Texas, Tucson Arizona, Rochester New York, Kentucky, Savannah Georgia, Green Bay Wisconsin, St. Petersburg Florida, Racine Wisconsin, Orem Utah, Cleveland Ohio, Buffalo New York, Meridian Idaho, Augusta Georgia, Iowa, New Mexico, Ohio, Caldwell Idaho, Lincoln Nebraska, Sioux City Iowa, Nampa Idaho, Albuquerque New Mexico, Ann Arbor Michigan, Iowa City Iowa, Phoenix Arizona, Chandler Arizona, Yonkers New York, Atlanta Georgia, Texas, Georgia, Austin Texas, Jacksonville Florida 06/17/2025
- Sr QNXT Analyst - Contracts Everett Washington, Albany New York, Kearney Nebraska, Roswell New Mexico, Chandler Arizona, Tucson Arizona, Akron Ohio, Columbus Ohio, Savannah Georgia, Nebraska, Kentucky, Nampa Idaho, Yonkers New York, St. Petersburg Florida, Louisville Kentucky, Cincinnati Ohio, Grand Rapids Michigan, New York, Utah, Phoenix Arizona, Austin Texas, Dallas Texas, Green Bay Wisconsin, Racine Wisconsin, Fort Worth Texas, Iowa City Iowa, Davenport Iowa, Tampa Florida, Bowling Green Kentucky, Scottsdale Arizona, Provo Utah, Augusta Georgia, Ann Arbor Michigan, Sterling Heights Michigan, Albuquerque New Mexico, Layton Utah, Orem Utah, Boise Idaho, Madison Wisconsin, Kenosha Wisconsin, New York New York, Covington Kentucky, Grand Island Nebraska, Cedar Rapids Iowa, Lincoln Nebraska, Seattle Washington, Florida, Columbus Georgia, Wisconsin, Santa Fe New Mexico, Meridian Idaho, Mesa Arizona, Omaha Nebraska, Warren Michigan, Bellevue Washington, Tacoma Washington, Salt Lake City Utah, Texas, San Antonio Texas, Atlanta Georgia, Syracuse New York, Buffalo New York, Rochester New York, Owensboro Kentucky, Spokane Washington, Miami Florida, Orlando Florida, Sioux City Iowa, Des Moines Iowa, Jacksonville Florida, Washington, Ohio, Iowa, Caldwell Idaho, Houston Texas, Detroit Michigan, Idaho, Cleveland Ohio, New Mexico, Michigan, Georgia, Las Cruces New Mexico, West Valley City Utah, Macon Georgia, Milwaukee Wisconsin, Rio Rancho New Mexico, Idaho Falls Idaho, Dayton Ohio, Lexington-Fayette Kentucky, Bellevue Nebraska, Vancouver Washington 06/19/2025
- Pharmacy Technician San Antonio Texas, Santa Fe New Mexico, Grand Island Nebraska, Vancouver Washington, Lincoln Nebraska, Wisconsin, New York, Tucson Arizona, Kearney Nebraska, Miami Florida, Omaha Nebraska, Dayton Ohio, Phoenix Arizona, Orem Utah, Syracuse New York, Salt Lake City Utah, Lexington-Fayette Kentucky, Covington Kentucky, Kentucky, Racine Wisconsin, Yonkers New York, Scottsdale Arizona, Houston Texas, Grand Rapids Michigan, Dallas Texas, Bellevue Nebraska, Savannah Georgia, Utah, Orlando Florida, Chandler Arizona, Kenosha Wisconsin, Columbus Ohio, Cedar Rapids Iowa, Ann Arbor Michigan, Layton Utah, Austin Texas, Sioux City Iowa, Washington, Iowa, New Mexico, Meridian Idaho, Cincinnati Ohio, Roswell New Mexico, Augusta Georgia, Davenport Iowa, Provo Utah, Caldwell Idaho, Louisville Kentucky, Fort Worth Texas, Columbus Georgia, Rochester New York, Atlanta Georgia, St. Petersburg Florida, Akron Ohio, Jacksonville Florida, Macon Georgia, Idaho Falls Idaho, Milwaukee Wisconsin, Sterling Heights Michigan, Bellevue Washington, Owensboro Kentucky, Nampa Idaho, Tacoma Washington, Green Bay Wisconsin, Georgia, Nebraska, Florida, Texas, Rio Rancho New Mexico, Des Moines Iowa, Iowa City Iowa, Cleveland Ohio, Albuquerque New Mexico, Madison Wisconsin, Las Cruces New Mexico, Albany New York, Boise Idaho, West Valley City Utah, Idaho, Mesa Arizona, Tampa Florida, Detroit Michigan, Bowling Green Kentucky, Spokane Washington, Everett Washington, Buffalo New York, Michigan, Ohio, Warren Michigan 07/24/2025
- Director, Protection Services Operations Center (Intelligence / Investigations) - REMOTE New Mexico, West Valley City Utah, Meridian Idaho, Louisville Kentucky, Des Moines Iowa, Ann Arbor Michigan, Jacksonville Florida, Miami Florida, Cleveland Ohio, Santa Fe New Mexico, Syracuse New York, New York, Owensboro Kentucky, Davenport Iowa, Houston Texas, Albany New York, Rio Rancho New Mexico, Racine Wisconsin, San Antonio Texas, Orem Utah, Orlando Florida, Michigan, Utah, Ohio, Sioux City Iowa, Provo Utah, Salt Lake City Utah, Dallas Texas, Cedar Rapids Iowa, Yonkers New York, Las Cruces New Mexico, Kentucky, Bellevue Nebraska, Savannah Georgia, Lincoln Nebraska, Nampa Idaho, Covington Kentucky, Tacoma Washington, Grand Island Nebraska, Everett Washington, Grand Rapids Michigan, Buffalo New York, Chandler Arizona, Kearney Nebraska, Atlanta Georgia, Albuquerque New Mexico, St. Petersburg Florida, Spokane Washington, Austin Texas, Madison Wisconsin, Idaho, Boise Idaho, Lexington-Fayette Kentucky, Sterling Heights Michigan, Tampa Florida, Kenosha Wisconsin, Fort Worth Texas, Columbus Ohio, Roswell New Mexico, Dayton Ohio, Florida, Georgia, Washington, Wisconsin, Caldwell Idaho, Green Bay Wisconsin, Omaha Nebraska, Macon Georgia, Vancouver Washington, Scottsdale Arizona, Warren Michigan, Columbus Georgia, Tucson Arizona, Augusta Georgia, Iowa City Iowa, Akron Ohio, Layton Utah, Detroit Michigan, Iowa, Nebraska, Bellevue Washington, Idaho Falls Idaho, Milwaukee Wisconsin, Mesa Arizona, Cincinnati Ohio, Bowling Green Kentucky, Phoenix Arizona, Rochester New York, Texas 06/27/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs