This RN will act as a Care Review Clinician supporting our Medicare members. The position is fully remote. Excellent computer skills and attention to detail are very important to multitask between ...
This RN will act as a Care Review Clinician supporting our Medicare members. The position is fully remote. Excellent computer skills and attention to detail are very important to multitask between ...
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Long Beach, CA · On-site +1
$23.76 - $51.49/hr
This RN will act as a Care Review Clinician supporting our Medicare members. The position is fully remote. Excellent computer skills and attention to detail are very important to multitask between ...
Care Review Clinician (RN) Remote
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
This RN will act as a Care Review Clinician supporting our Medicare members. The position is fully remote. Excellent computer skills and attention to detail are very important to multitask between ...
Care Review Clinician (RN) Remote
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
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Care Review Clinician (RN) Remote
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
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The position is fully remote. Excellent computer skills and attention to detail are very important ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ...
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This is a remote position. We are seeking a Registered Nurse Care Manager (RNCM) to provide clinical oversight for a team of non clinical Lead Care Managers. In this fully remote role, you will ...
Quick apply
This is a remote position. We are seeking a Registered Nurse Care Manager (RNCM) to provide clinical oversight for a team of non clinical Lead Care Managers. In this fully remote role, you will ...
Care Review Clinician (RN)
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
This RN will act as a Care Review Clinician supporting our Medicare members ... The position is fully remote. Excellent computer skills and attention to detail are very important ...
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Long Beach, CA · On-site +1
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This RN will act as a Care Review Clinician supporting our Medicare members ... The position is fully remote. Excellent computer skills and attention to detail are very important ...
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Care Review Clinician (RN) Remote
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
This RN will act as a Care Review Clinician supporting our Medicare members who have recently been ... This is a remote position and productivity is important. Preferred candidates will have previous ...
Care Review Clinician (RN) Remote
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
This RN will act as a Care Review Clinician supporting our Medicare members who have recently been ... This is a remote position and productivity is important. Preferred candidates will have previous ...
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Newport Beach, CA · Remote
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Newport Beach Position: RN Case Manager, Home Health Position Type: Full-Time Remote/Virtual Position: No Coverage Area: Anaheim & surrounding areas Find Your Passion and Purpose as an Registered ...
Quick apply
RN Case Manager, Home Health
Newport Beach, CA · Remote
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Long Beach, CA · Remote
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Utilization Review Supervisor RN
Rancho Cucamonga, CA · Remote
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Utilization Review Supervisor RN
Rancho Cucamonga, CA · Remote
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Quick apply
Utilization Review Supervisor RN
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Cover unplanned visit gaps (RN/LVN call-offs, same-day admission needs, urgent family requests ... remote position.
Quick apply
Cover unplanned visit gaps (RN/LVN call-offs, same-day admission needs, urgent family requests ... remote position.
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IRIS Self-Directed Personal Care (RN) (Dane County, WI)
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Remote in California only Are you ready to make a lasting impact and transform the healthcare space ... Job Summary The UM Nurse I - RN performs clinical review of authorization requests to determine ...
Utilization Management Nurse I, RN
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Entry Level Remote Rn information
See Anaheim, CA salary details
$7.80 - $13.96
0% of jobs
$13.96 - $20.11
0% of jobs
$20.11 - $26.26
4% of jobs
$26.26 - $32.42
18% of jobs
$33.23 is the 25th percentile. Wages below this are outliers.
$32.42 - $38.57
20% of jobs
The median wage is $41.11 / hr.
$38.57 - $44.73
18% of jobs
$50.27 is the 75th percentile. Wages above this are outliers.
$44.73 - $50.88
16% of jobs
$50.88 - $57.04
10% of jobs
$57.04 - $63.19
6% of jobs
$63.19 - $69.34
4% of jobs
$69.34 - $75.50
3% of jobs
$7
$44
$75
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How can I make 2000 a week working from home?
What is an entry level remote RN?
What are some common challenges faced by entry-level remote RNs, and how can they be overcome?
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How to make an extra $2000 a month as a nurse?

Full-time
Re-posted 17 hours ago
Molina Healthcare rating
8.0
Based on 197 frontline employees who took The Breakroom Quiz
161st of 300 rated insurance
Job description
This RN will act as a Care Review Clinician supporting our Medicare members. The position is fully remote. Excellent computer skills and attention to detail are very important to multitask between systems, talk with providers on the phone, and adhere to Medicare guidelines.
This is a remote position and productivity is important. Preferred candidates will have previous utilization management, managed care, or post-acute experience.
Schedule: Monday through Friday 8:30AM to 5:00PM EST (Occasional weekends, no nights, occasional holidays.)
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).
Recent hospital experience in an intensive care unit (ICU) or emergency room.
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
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About Molina Healthcare
Sourced by ZipRecruiter
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.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Long Beach, CA, US
Year founded
1980