The position is fully remote. Excellent computer skills and attention to detail are very important ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
The position is fully remote. Excellent computer skills and attention to detail are very important ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
Care Review Clinician (RN) - Remote in FL
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ... intensive care unit (ICU) or emergency room. * Utilization Management (UM) experience highly ...
Care Review Clinician (RN) - Remote in FL
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ... intensive care unit (ICU) or emergency room. * Utilization Management (UM) experience highly ...
Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ... Recent hospital experience in an intensive care unit (ICU) or emergency room. * Utilization ...
Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ... Recent hospital experience in an intensive care unit (ICU) or emergency room. * Utilization ...
Care Review Clinician (RN) - Remote in FL
Long Beach, CA · Remote
$26.41 - $43/hr
Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ... Recent hospital experience in an intensive care unit (ICU) or emergency room. * Utilization ...
Care Review Clinician (RN) - Remote in FL
Long Beach, CA · Remote
$26.41 - $43/hr
Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ... Recent hospital experience in an intensive care unit (ICU) or emergency room. * Utilization ...
(RN) Remote Care Review Clinician - Utilization Review
Long Beach, CA · On-site +1
$25.08 - $51.49/hr
SC Single state or Compact RN License. • Ability to prioritize and manage multiple deadlines. • ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
(RN) Remote Care Review Clinician - Utilization Review
Long Beach, CA · On-site +1
$25.08 - $51.49/hr
SC Single state or Compact RN License. • Ability to prioritize and manage multiple deadlines. • ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
(RN) Remote Care Review Clinician - Utilization Review
Long Beach, CA · Remote
$25.08 - $51.49/hr
Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
(RN) Remote Care Review Clinician - Utilization Review
Long Beach, CA · Remote
$25.08 - $51.49/hr
Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
**Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
**Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
**Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
**Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
**Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
**Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
This RN will act as a Care Review Clinician and provide clinical review support for Medicare ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
This RN will act as a Care Review Clinician and provide clinical review support for Medicare ... Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina ...
**Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
**Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
Registered Nurse (RN). License must be active and unrestricted in state of practice(Nevada ... Recent hospital experience in an intensive care unit (ICU) or emergency room. Working knowledge of ...
Registered Nurse (RN). License must be active and unrestricted in state of practice(Nevada ... Recent hospital experience in an intensive care unit (ICU) or emergency room. Working knowledge of ...
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 and provide clinical review support for Medicare ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
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 and provide clinical review support for Medicare ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
Care Review Clinician (RN)(Behavioral Health)
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
Care Review Clinician (RN)(Behavioral Health)
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
Remote Care Review Clinician- Utilization Review- NV RN license req.
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... (RN). License must be active and unrestricted in state of practice(Nevada). • Ability to ... an intensive care unit (ICU) or emergency room. Working knowledge of Sharepoint and MS Office ...
Remote Care Review Clinician- Utilization Review- NV RN license req.
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... (RN). License must be active and unrestricted in state of practice(Nevada). • Ability to ... an intensive care unit (ICU) or emergency room. Working knowledge of Sharepoint and MS Office ...
Care Review Clinician (RN)
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
Care Review Clinician (RN)
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
Care Review Clinician (RN) - Reside in PST
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
Care Review Clinician (RN) - Reside in PST
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ... an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are ...
ASC Registered Nurse II
Vacaville, CA · On-site +1
... U maternity unit, along with a cancer center, urgent care locations, and a growing network of ... Remote Work Disclosure NorthBay Health is primarily an onsite organization due to the nature of ...
ASC Registered Nurse II
Vacaville, CA · On-site +1
... U maternity unit, along with a cancer center, urgent care locations, and a growing network of ... Remote Work Disclosure NorthBay Health is primarily an onsite organization due to the nature of ...
NICU DIETITIAN
Bakersfield, CA · On-site +1
$80K - $95K/yr
Semi-Remote- Schedule flexibility offered (4 days onsite/1 day remote). Requirement : Registered ... We are seeking a NICU Dietitian to join the team. Salary: $80000-$95000 or based on experience ...
NICU DIETITIAN
Bakersfield, CA · On-site +1
$80K - $95K/yr
Semi-Remote- Schedule flexibility offered (4 days onsite/1 day remote). Requirement : Registered ... We are seeking a NICU Dietitian to join the team. Salary: $80000-$95000 or based on experience ...
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Molina Healthcare rating
8.1
Based on 193 frontline employees who took The Breakroom Quiz
133rd of 281 rated insurance
Job description
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
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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.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Long Beach, CA, US
Year founded
1980