Charleston, SC · Remote
$25.08 - $51.49/hr
SC Single state or Compact RN License. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and ...
Charleston, SC · Remote
$25.08 - $51.49/hr
SC Single state or Compact RN License. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and ...
Charleston, SC · Remote
This is a remote position with a requirement of a South Carolina resident and a BSN RN license. Minimum of 3 years of professional experience in related field required (i.e., maternal health, labor ...
Charleston, SC · Remote
This is a remote position with a requirement of a South Carolina resident and a BSN RN license. Minimum of 3 years of professional experience in related field required (i.e., maternal health, labor ...
This is a remote position with a requirement of a South Carolina resident and a BSN RN license. Minimum of 3 years of professional experience in related field required (i.e., maternal health, labor ...
This is a remote position with a requirement of a South Carolina resident and a BSN RN license. Minimum of 3 years of professional experience in related field required (i.e., maternal health, labor ...
An active, unrestricted Registered Nurse (RN). Key Responsibilities * Conduct comprehensive quality ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
An active, unrestricted Registered Nurse (RN). Key Responsibilities * Conduct comprehensive quality ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
This is a remote opportunity within the Low Country, Charleston and NE Columbia operational area ... Serves as a subject matter expert for clinical quality matters when collaborating with other RNs ...
This is a remote opportunity within the Low Country, Charleston and NE Columbia operational area ... Serves as a subject matter expert for clinical quality matters when collaborating with other RNs ...
Review and approve APP, RN, SW and PharmD plans of care. * Appropriate and timely patient document ... This position will be remote within the designated market with occasional in-home patient treatment ...
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Review and approve APP, RN, SW and PharmD plans of care. * Appropriate and timely patient document ... This position will be remote within the designated market with occasional in-home patient treatment ...
Review and approve APP, RN, SW and PharmD plans of care. * Appropriate and timely patient document ... This position will be remote within the designated market with occasional in-home patient treatment ...
Review and approve APP, RN, SW and PharmD plans of care. * Appropriate and timely patient document ... This position will be remote within the designated market with occasional in-home patient treatment ...
Charleston, SC · Remote
Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South ...
Charleston, SC · Remote
Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South ...
Charleston, SC · Remote
Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South ...
Charleston, SC · Remote
Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South ...
Charleston, SC · On-site +1
Active licensure in discipline (RN, RT, ETC) by the South Carolina Board of Nursing or a compact state required. Current Basic Life Support (BLS) required, either a certification from an American ...
Charleston, SC · On-site +1
Active licensure in discipline (RN, RT, ETC) by the South Carolina Board of Nursing or a compact state required. Current Basic Life Support (BLS) required, either a certification from an American ...
Summerville, SC · On-site +1
BSN RN or LICSW required. Role Overview: Responsible for managing and coordinating care, services ... Those fully remote associates residing in states where service is required by contract, law, or ...
Summerville, SC · On-site +1
BSN RN or LICSW required. Role Overview: Responsible for managing and coordinating care, services ... Those fully remote associates residing in states where service is required by contract, law, or ...
Summerville, SC · On-site +1
BSN RN or LICSW required. Role Overview: Responsible for managing and coordinating care, services ... Those fully remote associates residing in states where service is required by contract, law, or ...
Summerville, SC · On-site +1
BSN RN or LICSW required. Role Overview: Responsible for managing and coordinating care, services ... Those fully remote associates residing in states where service is required by contract, law, or ...
... RT/RN) background with cath lab exposure. Specialized Skills / Other Requirements SPECIALIZED ... TRAVEL REQUIRED: 25-50% #LI-KB1 #LI-remote At Teleflex, we follow a comprehensive hiring process.
... RT/RN) background with cath lab exposure. Specialized Skills / Other Requirements SPECIALIZED ... TRAVEL REQUIRED: 25-50% #LI-KB1 #LI-remote At Teleflex, we follow a comprehensive hiring process.
$25.08 - $51.49/hr
Full-time
Posted 16 days ago
8.0
Based on 196 frontline employees who took The Breakroom Quiz
147th of 281 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. SC Single state or Compact RN License.
• 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
Pay Range: $25.08 - $51.49 / 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
