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Remote Rn Ibclc Jobs in California (NOW HIRING)

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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

(RN) Remote Care Review Clinician - Utilization Review

Molina Healthcare

Long Beach, CA • Remote

$25.08 - $51.49/hr

Full-time

Re-posted 2 days ago

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 

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.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

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About Molina Healthcare

Sourced by ZipRecruiter

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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