Jacksonville, FL · 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 ...
Jacksonville, FL · 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 ...
Miami, FL · Remote
$47K - $52K/yr
Coordinate, track, and communicate patient referrals, prior authorizations, and medical records to ... Remote-first -- work from home anywhere within our approved states * Growth: Tailored professional ...
Quick apply
Miami, FL · Remote
$47K - $52K/yr
Coordinate, track, and communicate patient referrals, prior authorizations, and medical records to ... Remote-first -- work from home anywhere within our approved states * Growth: Tailored professional ...
Orlando, FL · Remote
$75K - $85K/yr
... RN with strong organizational skills who thrives in a fast-paced, remote healthcare environment ... Serve as first point of escalation for CC team questions on referrals, prior authorizations, DME ...
Orlando, FL · Remote
$75K - $85K/yr
... RN with strong organizational skills who thrives in a fast-paced, remote healthcare environment ... Serve as first point of escalation for CC team questions on referrals, prior authorizations, DME ...
Orlando, FL · Remote
$75K - $85K/yr
... RN with strong organizational skills who thrives in a fast-paced, remote healthcare environment ... Process and route incoming referrals, lab orders, prior authorizations, and home health orders to ...
Quick apply
Orlando, FL · Remote
$75K - $85K/yr
... RN with strong organizational skills who thrives in a fast-paced, remote healthcare environment ... Process and route incoming referrals, lab orders, prior authorizations, and home health orders to ...
Tampa, FL · On-site +1
$95K - $115K/yr
Nurse Practitioner Remote Care Partners Remote Care Partners is seeking a compassionate, experienced, and self-motivated Nurse Practitioner (APRN) to join our growing virtual care team. This is a ...
Tampa, FL · On-site +1
$95K - $115K/yr
Nurse Practitioner Remote Care Partners Remote Care Partners is seeking a compassionate, experienced, and self-motivated Nurse Practitioner (APRN) to join our growing virtual care team. This is a ...
Nurse Practitioner Remote Care Partners Remote Care Partners is seeking a compassionate, experienced, and self-motivated Nurse Practitioner (APRN) to join our growing virtual care team. This is a ...
Nurse Practitioner Remote Care Partners Remote Care Partners is seeking a compassionate, experienced, and self-motivated Nurse Practitioner (APRN) to join our growing virtual care team. This is a ...
Orlando, FL · Remote
$20/hr
Processing, monitoring, and managing prior authorizations and appeals to help patients initiate or continue therapy without interruption. * Communicating with patients, healthcare providers ...
Orlando, FL · Remote
$20/hr
Processing, monitoring, and managing prior authorizations and appeals to help patients initiate or continue therapy without interruption. * Communicating with patients, healthcare providers ...
Saint Petersburg, FL · On-site +1
$22 - $27/hr
Remote Travel Nurse Trainer - Licensed RN or APRN Type: Full-Time, Travel Nursing Who You Are You are a licensed nurse with a passion for aesthetics and education. You thrive in a remote-first ...
Saint Petersburg, FL · On-site +1
$22 - $27/hr
Remote Travel Nurse Trainer - Licensed RN or APRN Type: Full-Time, Travel Nursing Who You Are You are a licensed nurse with a passion for aesthetics and education. You thrive in a remote-first ...
Safety Harbor, FL · On-site +1
$20/hr
Updates patient referrals and authorization information into Practice Management (PM) software ... Able to train onsite in Safety Harbor, FL office for up to ninety (90) days prior to going remote
Safety Harbor, FL · On-site +1
$20/hr
Updates patient referrals and authorization information into Practice Management (PM) software ... Able to train onsite in Safety Harbor, FL office for up to ninety (90) days prior to going remote
West Palm Beach, FL · On-site +1
$75K - $140K/yr
Assesses the patients physical and mental status prior to procedures, educates on procedural and ... Not Authorized EDRP Authorized : Former EDRP participants ineligible to apply for incentive.
West Palm Beach, FL · On-site +1
$75K - $140K/yr
Assesses the patients physical and mental status prior to procedures, educates on procedural and ... Not Authorized EDRP Authorized : Former EDRP participants ineligible to apply for incentive.
Pensacola, FL · On-site +1
$16 - $20/hr
Position can be remote after required in office training if preferred. ESSENTIAL DUTIES AND ... Receive requests for prior authorizations through the electronic health record (EHR) and/or via ...
Pensacola, FL · On-site +1
$16 - $20/hr
Position can be remote after required in office training if preferred. ESSENTIAL DUTIES AND ... Receive requests for prior authorizations through the electronic health record (EHR) and/or via ...
Orlando, FL · Remote
$22 - $27/mo
Travel Nurse Trainer (RN/APRN) - Remote with Occasional Travel Employment Type: Full-Time | Work Schedule: 80% Remote / 20% Travel Role Overview We are seeking a licensed RN or APRN with experience ...
Orlando, FL · Remote
$22 - $27/mo
Travel Nurse Trainer (RN/APRN) - Remote with Occasional Travel Employment Type: Full-Time | Work Schedule: 80% Remote / 20% Travel Role Overview We are seeking a licensed RN or APRN with experience ...
Orlando, FL · On-site +1
$22 - $27/hr
Travel Nurse Trainer (RN/APRN) - Remote with Occasional Travel Employment Type: Full-Time | Work Schedule: 80% Remote / 20% Travel Role Overview We are seeking a licensed RN or APRN with experience ...
Orlando, FL · On-site +1
$22 - $27/hr
Travel Nurse Trainer (RN/APRN) - Remote with Occasional Travel Employment Type: Full-Time | Work Schedule: 80% Remote / 20% Travel Role Overview We are seeking a licensed RN or APRN with experience ...
Orlando, FL · On-site +1
$22 - $27/hr
Registered Nurse Trainer Employment Type: Full-Time Work Schedule: 80% Remote / 20% Travel Role Overview We are looking for a licensed RN or APRN with experience in aesthetics or med spa settings to ...
Orlando, FL · On-site +1
$22 - $27/hr
Registered Nurse Trainer Employment Type: Full-Time Work Schedule: 80% Remote / 20% Travel Role Overview We are looking for a licensed RN or APRN with experience in aesthetics or med spa settings to ...
Orlando, FL · Remote
$22 - $27/hr
Registered Nurse Trainer Employment Type: Full-Time Work Schedule: 80% Remote / 20% Travel Role Overview We are looking for a licensed RN or APRN with experience in aesthetics or med spa settings to ...
Orlando, FL · Remote
$22 - $27/hr
Registered Nurse Trainer Employment Type: Full-Time Work Schedule: 80% Remote / 20% Travel Role Overview We are looking for a licensed RN or APRN with experience in aesthetics or med spa settings to ...
S. were studied in clinical trials with FCS participation prior to approval. Through our ... The Occupational Health Registered Nurse I advocates for health promotion, prevention of illness ...
S. were studied in clinical trials with FCS participation prior to approval. Through our ... The Occupational Health Registered Nurse I advocates for health promotion, prevention of illness ...
Bay Pines, FL · On-site +1
$78K - $150K/yr
Authorized to highly qualified and eligible new federal appointees or former federal employees with ... prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
Bay Pines, FL · On-site +1
$78K - $150K/yr
Authorized to highly qualified and eligible new federal appointees or former federal employees with ... prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
Sarasota, FL · Remote
$22 - $27/hr
Travel Nurse Trainer (RN/APRN) - Join Our Wellness Network Top Highlights: * 80% remote | 20% travel * First 2 weeks on-site orientation * Create training modules and conduct virtual sessions
Sarasota, FL · Remote
$22 - $27/hr
Travel Nurse Trainer (RN/APRN) - Join Our Wellness Network Top Highlights: * 80% remote | 20% travel * First 2 weeks on-site orientation * Create training modules and conduct virtual sessions
West Palm Beach, FL · On-site +1
$74K - $137K/yr
Not authorized EDRP Authorized : Former EDRP participants ineligible to apply for incentive ... prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
West Palm Beach, FL · On-site +1
$74K - $137K/yr
Not authorized EDRP Authorized : Former EDRP participants ineligible to apply for incentive ... prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
Sarasota, FL · On-site +1
$22 - $27/hr
Travel Nurse Trainer (RN/APRN) - Join Our Wellness Network Top Highlights: * 80% remote | 20% travel * First 2 weeks on-site orientation * Create training modules and conduct virtual sessions
Sarasota, FL · On-site +1
$22 - $27/hr
Travel Nurse Trainer (RN/APRN) - Join Our Wellness Network Top Highlights: * 80% remote | 20% travel * First 2 weeks on-site orientation * Create training modules and conduct virtual sessions
| Aspect | Remote Prior Authorization Rn | Remote Medical Coder |
|---|---|---|
| Credentials | RN license, certification in case management or utilization review | Certification in coding (CPC, CCS), high school diploma or equivalent |
| Work Environment | Healthcare facilities, insurance companies, telehealth | Medical offices, insurance companies, remote coding platforms |
| Industry Usage | Utilization review, patient authorization, insurance approval | Medical record review, billing, coding for insurance claims |
Remote Prior Authorization Rns focus on reviewing patient information to approve treatments, while Remote Medical Coders translate medical records into codes for billing. Both roles require healthcare knowledge but serve different functions within the healthcare industry.
$26.41 - $43/hr
Full-time
Re-posted 15 days ago
8.1
Based on 193 frontline employees who took The Breakroom Quiz
134th of 281 rated insurance
JOB DESCRIPTION
Must reside in Florida
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.
#PJHS3
#LI-AC1
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: $26.41 - $43 / 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
