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Remote Rn Ibclc Jobs in California (NOW HIRING)

Molina Healthcare

Care Manager, LTSS (RN)

Long Beach, CA · On-site +1

$26.41 - $51.49/hr

***Remote and will travel throughout the Southwest and Western regions of Wisconsin for member ... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ...

Astrana Health, Inc.

Care Manager I - RN

Monterey Park, CA · On-site +1

$78K - $91K/yr

Care Manager I - RN Department: Population Health Employment Type: Full Time Location: 1600 ... This is a remote position. The home office is located at 1600 Corporate Center Dr., Monterey Park ...

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Remote Rn Ibclc information

What is the difference between Remote Rn Ibclc vs Remote Rn Certified Diabetes Educator?

AspectRemote Rn IbclcRemote Rn Certified Diabetes Educator
CertificationsRN license, IBCLC certificationRN license, Certified Diabetes Educator (CDE)
Work EnvironmentHealthcare facilities, telehealth, clinicsDiabetes management programs, telehealth, clinics
Industry UsageMaternal and infant health, lactation consultingChronic disease management, diabetes education

Both roles require an RN license, but the Remote Rn Ibclc focuses on lactation consulting, while the Remote Rn Certified Diabetes Educator specializes in diabetes management. Their work environments often overlap in telehealth settings, but their certifications and patient focus differ significantly.

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Remote Rn Ibclc jobs near you

Care Review Clinician (RN) Remote (AZ)

Molina Healthcare

Long Beach, CA • On-site, Remote

$26.41 - $51.49/hr

Full-time

This job post has expired today. Applications are no longer accepted.

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 198 frontline employees who took The Breakroom Quiz

163rd of 303 rated insurance

Job description


JOB DESCRIPTION
This position will support the Arizona state Plan. We are seeking a candidate with an Arizona RN licensure. The ideal candidate will have experience with UM and prior authorization with both inpatient and outpatient. Candidates with a Behavioral Health background are highly preferred. Further details to be discussed during our interview process. Prefers candidates with 3 years of experience.
Remote position, must reside in Arizona.
Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time with some weekends and 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

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