San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
... years utilization review/manage care experience Prior supervisory experience with the ability to ... Basic computer skills including Outlook, WORD, Microsoft suite and VPN or other remote access ...
... years utilization review/manage care experience Prior supervisory experience with the ability to ... Basic computer skills including Outlook, WORD, Microsoft suite and VPN or other remote access ...
San Francisco, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Francisco, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Bakersfield, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Bakersfield, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Fresno, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Fresno, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Remote Role Responsibilities * Review and assess clinical documentation for accuracy, completeness ... Experience in CDI, case management, utilization review, or quality improvement. * Exposure to ...
Quick apply
Remote Role Responsibilities * Review and assess clinical documentation for accuracy, completeness ... Experience in CDI, case management, utilization review, or quality improvement. * Exposure to ...
Remote Role Responsibilities * Review and evaluate AI-generated clinical outputs based on nursing ... Experience reviewing charts for quality improvement, utilization review, CDI, or clinical ...
Quick apply
Remote Role Responsibilities * Review and evaluate AI-generated clinical outputs based on nursing ... Experience reviewing charts for quality improvement, utilization review, CDI, or clinical ...
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
San Francisco, CA · Remote
$60 - $80/hr
Remote Role Responsibilities * Review and assess clinical documentation for accuracy, completeness ... Experience in CDI, case management, utilization review, or quality improvement. * Exposure to ...
Quick apply
San Francisco, CA · Remote
$60 - $80/hr
Remote Role Responsibilities * Review and assess clinical documentation for accuracy, completeness ... Experience in CDI, case management, utilization review, or quality improvement. * Exposure to ...
Cerritos, CA · Remote
$275K - $325K/yr
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
Quick apply
Cerritos, CA · Remote
$275K - $325K/yr
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
Rancho Cordova, CA · Remote
$53.46 - $79.52/hr
As a remote employee, we will provide you with the equipment needed to work from home, including a ... Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory ...
Rancho Cordova, CA · Remote
$53.46 - $79.52/hr
As a remote employee, we will provide you with the equipment needed to work from home, including a ... Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory ...
Rancho Cordova, CA · Remote
$53.46 - $79.52/hr
As a remote employee, we will provide you with the equipment needed to work from home, including a ... Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory ...
Rancho Cordova, CA · Remote
$53.46 - $79.52/hr
As a remote employee, we will provide you with the equipment needed to work from home, including a ... Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory ...
San Francisco, CA · Remote
$120K - $130K/yr
Work Environment This position is fully remote, allowing for a flexible work-life balance while ... Work closely with the Utilization Review Department to coordinate authorizations for services and ...
San Francisco, CA · Remote
$120K - $130K/yr
Work Environment This position is fully remote, allowing for a flexible work-life balance while ... Work closely with the Utilization Review Department to coordinate authorizations for services and ...
San Francisco, CA · Remote
$55 - $65/hr
Remote Role Responsibilities * Review and evaluate AI-generated clinical outputs based on nursing ... Experience reviewing charts for quality improvement, utilization review, CDI, or clinical ...
Quick apply
San Francisco, CA · Remote
$55 - $65/hr
Remote Role Responsibilities * Review and evaluate AI-generated clinical outputs based on nursing ... Experience reviewing charts for quality improvement, utilization review, CDI, or clinical ...
| Aspect | Remote Weekend Utilization Review | Remote Weekday Utilization Review |
|---|---|---|
| Credentials | Typically requires a healthcare professional license and utilization review certification | Same as weekend role, healthcare license and utilization review certification |
| Work Environment | Remote, weekend hours, often part-time or flexible | Remote, weekday hours, standard business hours |
| Employer & Industry | Health insurance companies, third-party administrators | Same as weekend role, health insurance industry |
| Work Schedule | Primarily weekends, possibly evenings | Weekdays, regular business hours |
Remote Weekend Utilization Review and Remote Weekday Utilization Review roles are similar in credentials and industry but differ mainly in work schedule. Weekend roles focus on reviewing cases during weekends, offering flexibility, while weekday roles follow standard business hours. Both positions require healthcare licensing and utilization review certification, serving health insurance companies and third-party administrators.
The most popular types of Weekend Utilization Review jobs in California are:
For Remote Weekend Utilization Review jobs in California, the most frequently searched job titles are:
The top searched job categories for Remote Weekend Utilization Review jobs in California are:
Cities in California with the most Remote Weekend Utilization Review job openings:
San Diego, CA • Remote
$30.37 - $59.21/hr
Full-time
Re-posted 11 days ago
8.0
Based on 199 frontline employees who took The Breakroom Quiz
167th of 311 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).
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred.
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: $30.37 - $59.21 / 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
