Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
Irvine, CA · On-site +1
$68.86/hr
Performs the appropriate utilization review functions utilizing medical staff-approved decision support criteria (InterQual Intensity of Service, Severity of Illness criteria). Analyzes and ...
Irvine, CA · On-site +1
$68.86/hr
Performs the appropriate utilization review functions utilizing medical staff-approved decision support criteria (InterQual Intensity of Service, Severity of Illness criteria). Analyzes and ...
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
Roseville, CA · On-site +1
$59.23 - $81.24/hr
Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments ... Two years' utilization review experience using the Optum/Inter Qual product within the last 12 ...
New
Roseville, CA · On-site +1
$59.23 - $81.24/hr
Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments ... Two years' utilization review experience using the Optum/Inter Qual product within the last 12 ...
New
San Francisco, CA · Remote
$60 - $80/hr
Remote Role Responsibilities * Review and assess clinical documentation for accuracy, completeness ... Experience in CDI, case management, utilization review, or quality improvement. * Exposure to ...
Quick apply
San Francisco, CA · Remote
$60 - $80/hr
Remote Role Responsibilities * Review and assess clinical documentation for accuracy, completeness ... Experience in CDI, case management, utilization review, or quality improvement. * Exposure to ...
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
Preferred candidates will have previous utilization management, case management, managed care, or ... services review assessment processes. Responsible for verifying that services are medically ...
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
Preferred candidates will have previous utilization management, case management, managed care, or ... services review assessment processes. Responsible for verifying that services are medically ...
Cerritos, CA · Remote
$275K - $325K/yr
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
Quick apply
Cerritos, CA · Remote
$275K - $325K/yr
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
El Segundo, CA · Remote
$29 - $52/hr
Background involving utilization review for an insurance company or experience in case management * Ability to use your diverse knowledge and experience to make health care work better for our ...
El Segundo, CA · Remote
$29 - $52/hr
Background involving utilization review for an insurance company or experience in case management * Ability to use your diverse knowledge and experience to make health care work better for our ...
San Francisco, CA · On-site +1
$50 - $70/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Hindi Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
San Francisco, CA · On-site +1
$50 - $70/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Hindi Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
Los Angeles, CA · On-site +1
$70/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Hebrew Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
Los Angeles, CA · On-site +1
$70/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Hebrew Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
San Francisco, CA · On-site +1
$50/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Hebrew Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
San Francisco, CA · On-site +1
$50/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Hebrew Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
Los Angeles, CA · On-site +1
$34/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Portuguese Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
Los Angeles, CA · On-site +1
$34/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Portuguese Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
Los Angeles, CA · On-site +1
$30 - $50/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in French Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
Los Angeles, CA · On-site +1
$30 - $50/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in French Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
San Francisco, CA · On-site +1
$50K - $200K/yr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Korean Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
San Francisco, CA · On-site +1
$50K - $200K/yr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Korean Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
Los Angeles, CA · On-site +1
$50/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Hebrew Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
Los Angeles, CA · On-site +1
$50/hr
Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Fluency in Hebrew Familiarity with ... We seek attorneys to assist with document review, privilege review, expert testimony, legal ...
| Aspect | Assistant Remote Utilization Review | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license, certification in case management or utilization review | Registered Nurse (RN) license, often with additional certifications in case management or utilization review |
| Work Environment | Remote, administrative setting, telehealth or telecommuting | Remote or hospital/clinic settings, primarily telehealth or administrative |
| Employer & Industry | Health insurance companies, managed care organizations, healthcare providers | Hospitals, insurance companies, healthcare organizations |
Both roles involve reviewing patient cases to determine appropriate care and resource utilization. The Assistant Remote Utilization Review typically supports the process with administrative tasks and basic review, while the Utilization Review Nurse performs more in-depth clinical assessments. Both require nursing credentials and often work remotely within healthcare or insurance industries.
Los Angeles, CA • Remote
$30.37 - $59.21/hr
Full-time
This job post has expired today. Applications are no longer accepted.
8.0
Based on 197 frontline employees who took The Breakroom Quiz
163rd of 301 rated insurance
JOB DESCRIPTION Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/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 reviews to determine prior authorization/financial responsibility for Molina and its members.
• Processes requests within required timelines.
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
• Requests additional information from members or providers as needed.
• Makes appropriate referrals to other clinical programs.
• Collaborates with multidisciplinary teams to promote the Molina care model.
• Adheres to utilization management (UM) policies and procedures.
Required Qualifications
• At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Certified Professional in Healthcare Management (CPHM).
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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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.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
