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Full Time Remote Rn Chart Review Jobs in California

Astrana Health

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

This is a remote position for CA-licensed nurses. Candidates must live in California. We are ... Complete prior authorization/retrospective review of elective inpatient admissions, outpatient ...

Alignment Healthcare

Care Management Trainer

Orange, CA · On-site +1

$85K - $128K/yr

The specialist also performs call and chart quality audits and reviews, reviewing results with ... Current RN license Essential Physical Functions: The physical demands described here are ...

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Full Time Remote Rn Chart Review information

What is the difference between Full Time Remote Rn Chart Review vs Full Time Remote LPN Chart Review?

AspectFull Time Remote Rn Chart ReviewFull Time Remote LPN Chart Review
CredentialsRegistered Nurse (RN) licenseLicensed Practical Nurse (LPN) license
Work EnvironmentRemote, healthcare documentation reviewRemote, healthcare documentation review
Industry UsageCommon in healthcare, insurance, and legal sectorsLess common, primarily in healthcare documentation
Job FocusDetailed medical record review, complex case analysisBasic record review, data entry, and documentation

While both roles involve remote healthcare documentation review, RNs typically handle more complex cases requiring clinical expertise, whereas LPNs focus on more routine record reviews. The choice depends on your credentials and desired level of clinical involvement.

What are the most commonly searched types of Remote Rn Chart Review jobs in California? The most popular types of Remote Rn Chart Review jobs in California are:
What cities in California are hiring for Full Time Remote Rn Chart Review jobs? Cities in California with the most Full Time Remote Rn Chart Review job openings:
Full Time Remote Rn Chart Review jobs near you
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

Molina Healthcare

San Jose, CA • Remote

$30.37 - $59.21/hr

Full-time

Posted 13 hours ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

143rd of 277 rated insurance

Job description

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.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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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

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