Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
Long Beach, CA · Remote
$29.05 - $56.64/hr
Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for ... At least 2 years clinical nursing experience, including at least 1 year of utilization review ...
New
Long Beach, CA · Remote
$29.05 - $56.64/hr
Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for ... At least 2 years clinical nursing experience, including at least 1 year of utilization review ...
New
Columbus, OH · On-site
$29.05 - $56.64/hr
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
Columbus, OH · On-site
$29.05 - $56.64/hr
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
Long Beach, CA · Remote
$29.05 - $56.64/hr
Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for ... At least 2 years clinical nursing experience, including at least 1 year of utilization review ...
Long Beach, CA · Remote
$29.05 - $56.64/hr
Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for ... At least 2 years clinical nursing experience, including at least 1 year of utilization review ...
Job Qualifications REQUIRED QUALIFICATIONS: • At least 2 years clinical nursing experience ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Qualifications REQUIRED QUALIFICATIONS: • At least 2 years clinical nursing experience ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$23.76 - $51.49/hr
... . License must be active and unrestricted in state of practice. • Ability to prioritize and ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
$23.76 - $51.49/hr
... . License must be active and unrestricted in state of practice. • Ability to prioritize and ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Long Beach, CA · Remote
$25.08 - $51.49/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its ... Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single ...
Long Beach, CA · Remote
$25.08 - $51.49/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its ... Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single ...
San Jose, CA · On-site
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
San Jose, CA · On-site
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
San Diego, CA · On-site
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
San Diego, CA · On-site
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
$26.41 - $43/hr
... . License must be active and unrestricted in state of practice. • Ability to prioritize and ... Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an ...
New
$26.41 - $43/hr
... . License must be active and unrestricted in state of practice. • Ability to prioritize and ... Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an ...
New
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
New
$25.08 - $51.49/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its ... Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single ...
New
$25.08 - $51.49/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its ... Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single ...
New
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Columbus, OH · On-site
$23.76 - $51.49/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its ... Registered Nurse (RN). License must be active and unrestricted in state of practice. * Ability to ...
New
Columbus, OH · On-site
$23.76 - $51.49/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its ... Registered Nurse (RN). License must be active and unrestricted in state of practice. * Ability to ...
New
This RN Case Manager position is dedicated exclusively to postpartum members and differs from a ... While the standard reflects Molina's broader Case Manager framework, this position focuses on ...
This RN Case Manager position is dedicated exclusively to postpartum members and differs from a ... While the standard reflects Molina's broader Case Manager framework, this position focuses on ...
Long Beach, CA · Remote
$26.41 - $43/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ...
Long Beach, CA · Remote
$26.41 - $43/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ...
Wenatchee, WA · On-site
$26.41 - $59.21/hr
This RN Case Manager position is dedicated exclusively to postpartum members and differs from a ... While the standard reflects Molina's broader Case Manager framework, this position focuses on ...
Wenatchee, WA · On-site
$26.41 - $59.21/hr
This RN Case Manager position is dedicated exclusively to postpartum members and differs from a ... While the standard reflects Molina's broader Case Manager framework, this position focuses on ...
Long Beach, CA · On-site
$26.41 - $59.21/hr
This RN Case Manager position is dedicated exclusively to postpartum members and differs from a ... While the standard reflects Molina's broader Case Manager framework, this position focuses on ...
Long Beach, CA · On-site
$26.41 - $59.21/hr
This RN Case Manager position is dedicated exclusively to postpartum members and differs from a ... While the standard reflects Molina's broader Case Manager framework, this position focuses on ...
Vancouver, WA · On-site
$26.41 - $59.21/hr
This RN Case Manager position is dedicated exclusively to postpartum members and differs from a ... While the standard reflects Molina's broader Case Manager framework, this position focuses on ...
Vancouver, WA · On-site
$26.41 - $59.21/hr
This RN Case Manager position is dedicated exclusively to postpartum members and differs from a ... While the standard reflects Molina's broader Case Manager framework, this position focuses on ...
$17.31 - $21.68
3% of jobs
$21.68 - $26.05
7% of jobs
$29.33 is the 25th percentile. Wages below this are outliers.
$26.05 - $30.42
20% of jobs
The median wage is $34.13 / hr.
$30.42 - $34.79
24% of jobs
$34.79 - $39.16
14% of jobs
$41.84 is the 75th percentile. Wages above this are outliers.
$39.16 - $43.53
11% of jobs
$43.53 - $47.90
7% of jobs
$47.90 - $52.27
5% of jobs
$52.27 - $56.64
3% of jobs
$56.64 - $61.01
3% of jobs
$61.01 - $65.38
2% of jobs
$17
$38
$65
A Molina Nurse typically conducts patient assessments, coordinates care plans, and follows up with members to monitor progress and ensure they receive appropriate healthcare services. Daily tasks often include telephonic outreach, documenting patient interactions in electronic health records, and collaborating with physicians, social workers, and other healthcare professionals to address patient needs. The role may also involve educating members about preventive care, medication adherence, and managing chronic conditions. This blend of clinical and case management responsibilities helps Molina Nurses support members' overall health and well-being in a managed care environment.
A Molina Nurse is a registered nurse (RN) or licensed vocational/practical nurse (LVN/LPN) who works for Molina Healthcare, a managed care organization. They provide case management, care coordination, and utilization review for members, ensuring they receive appropriate medical services. Molina Nurses often work remotely or in clinical settings, collaborating with healthcare providers to improve patient outcomes. Their role focuses on preventive care, chronic disease management, and patient education while supporting Molina’s mission to provide quality healthcare to underserved populations.
To thrive as a Molina Nurse, you need a current registered nursing license, strong clinical assessment abilities, and experience in managed care or case management. Familiarity with electronic health records (EHRs), patient documentation software, and care coordination systems is highly valuable. Excellent communication, problem-solving, and organizational skills help build trust with patients and facilitate collaboration with interdisciplinary teams. These skills and qualifications ensure effective patient advocacy, improved health outcomes, and compliance with Molina Healthcare’s standards and protocols.

8.0
Based on 198 frontline employees who took The Breakroom Quiz
163rd of 304 rated insurance
Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
Job Duties
Facilitates medical review of prospective, retrospective, and concurrent review of appeals for denied prior authorizations. Includes standard and expedited cases, inpatient, outpatient, and pharmaceutical authorization appeals.
Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing.
Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions.
Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers.
Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues.
Identifies and reports quality of care issues.
Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience.
Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings.
Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions.
Supplies criteria supporting all recommendations for denial or modification of payment decisions.
Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals.
Provides training and support to clinical peers.
Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols.
At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact license is acceptable where states allow.
Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and
Healthcare Common Procedure Coding (HCPC).
Experience working within applicable state, federal, and third-party regulations.
Analytic, problem-solving, and decision-making skills.
Organizational and time-management skills.
Attention to detail.
Critical-thinking and active listening skills.
Common look proficiency.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software program(s) proficiency.
Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications.
Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics.
Billing and coding experience.
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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