Jackson, MS · Remote
$23.76 - $51.49/hr
... 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. • ...
New
Jackson, MS · Remote
$23.76 - $51.49/hr
... 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. • ...
New
Gulfport, MS · On-site +1
Case Management Pharmacist - Coordinate Care and Improve Patient Outcomes A confidential managed ... nurses, and care coordinators to manage high-risk or complex patients. * Conduct medication reviews ...
Gulfport, MS · On-site +1
Case Management Pharmacist - Coordinate Care and Improve Patient Outcomes A confidential managed ... nurses, and care coordinators to manage high-risk or complex patients. * Conduct medication reviews ...
Jackson, MS · On-site +1
Case Management Pharmacist - Coordinate Care and Improve Patient Outcomes A confidential managed ... nurses, and care coordinators to manage high-risk or complex patients. * Conduct medication reviews ...
Jackson, MS · On-site +1
Case Management Pharmacist - Coordinate Care and Improve Patient Outcomes A confidential managed ... nurses, and care coordinators to manage high-risk or complex patients. * Conduct medication reviews ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Gulfport, MS · On-site +1
$57 - $69.50/hr
Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...
Gulfport, MS · On-site +1
$57 - $69.50/hr
Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...
Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...
Quick apply
Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...
Flexible schedule Home Infusion RN - Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered ...
Flexible schedule Home Infusion RN - Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered ...
Cleveland, MS · Remote
Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...
Quick apply
Cleveland, MS · Remote
Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...
Greenville, MS · Remote
Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...
Quick apply
Greenville, MS · Remote
Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...
Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...
Quick apply
Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...
Calhoun City, MS · On-site +1
Computer literacy Preferred/Desired Licensure Minimum Required * RN;BLS CERTIFICATION WITHIN 14 DAYS OF HIRE Preferred/Desired * ACLS/PALS Specialty Certification
Calhoun City, MS · On-site +1
Computer literacy Preferred/Desired Licensure Minimum Required * RN;BLS CERTIFICATION WITHIN 14 DAYS OF HIRE Preferred/Desired * ACLS/PALS Specialty Certification
Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...
Quick apply
Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...
Jackson, MS · Remote
$25/hr
... review documents for complex litigation matters using an electronic review platform to code for ... Remote work-from-home opportunity * Pay rate: $25 per hour * Duration depends on the project ...
Jackson, MS · Remote
$25/hr
... review documents for complex litigation matters using an electronic review platform to code for ... Remote work-from-home opportunity * Pay rate: $25 per hour * Duration depends on the project ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · Remote
$100 - $150/hr
Design and implement robust legal rubrics for use in AI-driven document review and analysis ... Develop case strategies and motion practice templates that inform machine learning models in legal ...
Jackson, MS · On-site +1
$79K - $147K/yr
... after review of the EDRP application. Former EDRP participants ineligible to apply. Learn more ... by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 ...
Jackson, MS · On-site +1
$79K - $147K/yr
... after review of the EDRP application. Former EDRP participants ineligible to apply. Learn more ... by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 ...
| Aspect | Remote Rn Case Review | Remote Rn Utilization Review |
|---|---|---|
| Credentials | Registered Nurse (RN), licensure, case review certifications | Registered Nurse (RN), licensure, utilization review certifications |
| Work Environment | Remote, healthcare settings, insurance companies | Remote, healthcare settings, insurance companies |
| Employer & Industry | Hospitals, insurance firms, healthcare providers | Insurance companies, healthcare management organizations |
Remote Rn Case Review and Remote Rn Utilization Review roles both involve remote nursing work within the healthcare and insurance industries. While they share similar credentials and work environments, case review focuses on evaluating individual patient cases, whereas utilization review assesses the necessity and appropriateness of healthcare services. Understanding these distinctions helps job seekers identify the right role based on their skills and career goals.
$23.76 - $51.49/hr
Full-time
Posted 2 days ago
8.0
Based on 192 frontline employees who took The Breakroom Quiz
147th of 261 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.
• 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: $23.76 - $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
