Charleston, SC · Remote
$25.08 - $51.49/hr
... prior authorization/financial responsibility for Molina and its members. • Processes requests ... SC Single state or Compact RN License. • Ability to prioritize and manage multiple deadlines. • ...
Charleston, SC · Remote
$25.08 - $51.49/hr
... prior authorization/financial responsibility for Molina and its members. • Processes requests ... SC Single state or Compact RN License. • Ability to prioritize and manage multiple deadlines. • ...
Charleston, SC · On-site +1
$68K - $137K/yr
Not authorized. Requirements Help Conditions of employment * U.S. Citizenship; non-citizens may ... prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
Charleston, SC · On-site +1
$68K - $137K/yr
Not authorized. Requirements Help Conditions of employment * U.S. Citizenship; non-citizens may ... prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
Goose Creek, SC · On-site +1
$42K - $67K/yr
Completed work should need only a general review by a registered nurse or physician for ... EDRP Authorized: Former EDRP participants ineligible to apply for incentive. Contact ...
Goose Creek, SC · On-site +1
$42K - $67K/yr
Completed work should need only a general review by a registered nurse or physician for ... EDRP Authorized: Former EDRP participants ineligible to apply for incentive. Contact ...
Charleston, SC · On-site +1
$42K - $67K/yr
Completed work should need only a general review by a registered nurse or physician for ... EDRP Authorized: Former EDRP participants ineligible to apply for incentive. Contact ...
Charleston, SC · On-site +1
$42K - $67K/yr
Completed work should need only a general review by a registered nurse or physician for ... EDRP Authorized: Former EDRP participants ineligible to apply for incentive. Contact ...
An active, unrestricted Registered Nurse (RN). Key Responsibilities * Conduct comprehensive quality ... Prior experience in a dedicated auditor or quality oversight role * Experience working in health ...
An active, unrestricted Registered Nurse (RN). Key Responsibilities * Conduct comprehensive quality ... Prior experience in a dedicated auditor or quality oversight role * Experience working in health ...
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 ...
Charleston, SC · Remote
$180K - $215K/yr
Minimal administrative burden in a fully remote, outpatient model What your day-to-day practice ... authorized to work in the U.S. only after a job offer is accepted and Form I-9 is completed. For ...
Quick apply
Charleston, SC · Remote
$180K - $215K/yr
Minimal administrative burden in a fully remote, outpatient model What your day-to-day practice ... authorized to work in the U.S. only after a job offer is accepted and Form I-9 is completed. For ...
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 ...
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 · Remote
$50K - $100K/yr
No prior experience required -- full training provided * Must have been out of high school for at ... Legally authorized to work in the United States and reside in a U.S. state Compensation:
Quick apply
Charleston, SC · Remote
$50K - $100K/yr
No prior experience required -- full training provided * Must have been out of high school for at ... Legally authorized to work in the United States and reside in a U.S. state Compensation:
... Psychiatric Mental Health Nurse Practitioners (PMHNP). In this remote, independent contract ... prior to the commencement of credentialing. * Technical proficiency in navigating remote health ...
Quick apply
... Psychiatric Mental Health Nurse Practitioners (PMHNP). In this remote, independent contract ... prior to the commencement of credentialing. * Technical proficiency in navigating remote health ...
... Psychiatric Mental Health Nurse Practitioners (PMHNP). In this remote, independent contract ... prior to the commencement of credentialing. * Technical proficiency in navigating remote health ...
... Psychiatric Mental Health Nurse Practitioners (PMHNP). In this remote, independent contract ... prior to the commencement of credentialing. * Technical proficiency in navigating remote health ...
Charleston, SC · Remote
$92K - $115K/yr
As a Remote Ultrasound Interpretation Clinician, you'll play a vital role in supporting timely ... Providers without prior ultrasound interpretation experience should demonstrate an interest in ...
Charleston, SC · Remote
$92K - $115K/yr
As a Remote Ultrasound Interpretation Clinician, you'll play a vital role in supporting timely ... Providers without prior ultrasound interpretation experience should demonstrate an interest in ...
Charleston, SC · On-site +1
$149K - $206K/yr
You will work in a remote environment, reporting to our Associate Director, Advanced practice ... FL, TX, AZ, GA, LA, NC, SC, MS, VA prior to the start of employment Preferred Qualifications:
Charleston, SC · On-site +1
$149K - $206K/yr
You will work in a remote environment, reporting to our Associate Director, Advanced practice ... FL, TX, AZ, GA, LA, NC, SC, MS, VA prior to the start of employment Preferred Qualifications:
Charleston, SC · On-site +1
T3 Trading Group, LLC ( www.t3trading.com ) is a Registered SEC Broker-Dealer & Member of FINRA ... Prior trading experience is not required Professional Trading Benefits As a professional trader ...
Charleston, SC · On-site +1
T3 Trading Group, LLC ( www.t3trading.com ) is a Registered SEC Broker-Dealer & Member of FINRA ... Prior trading experience is not required Professional Trading Benefits As a professional trader ...
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 ...
Quick apply
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
$50K - $120K/yr
... Firefighters, Nurses, and now, Veterans. For over 60 years, we have been the #1 provider of ... No prior experience required! Our industry-leading training and support will equip you with the ...
Quick apply
Charleston, SC · Remote
$50K - $120K/yr
... Firefighters, Nurses, and now, Veterans. For over 60 years, we have been the #1 provider of ... No prior experience required! Our industry-leading training and support will equip you with the ...
$6.97 - $12.47
0% of jobs
$12.47 - $17.98
0% of jobs
$17.98 - $23.48
4% of jobs
$23.48 - $28.98
18% of jobs
$29.70 is the 25th percentile. Wages below this are outliers.
$28.98 - $34.48
20% of jobs
The median wage is $36.74 / hr.
$34.48 - $39.98
18% of jobs
$44.93 is the 75th percentile. Wages above this are outliers.
$39.98 - $45.48
16% of jobs
$45.48 - $50.98
10% of jobs
$50.98 - $56.48
6% of jobs
$56.48 - $61.99
4% of jobs
$61.99 - $67.49
3% of jobs
$6
$39
$67
| 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.
$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
