Columbus, OH · On-site
$23.76 - $51.49/hr
Seeking a Registered Nurse with a OH or compact license. The Care Review Clinician will provide ... Prefer candidates that have experience with ASAM, MCG or previous experience with Utilization ...
Columbus, OH · On-site
$23.76 - $51.49/hr
Seeking a Registered Nurse with a OH or compact license. The Care Review Clinician will provide ... Prefer candidates that have experience with ASAM, MCG or previous experience with Utilization ...
Columbus, OH · On-site
Conducts prior authorization reviews to determine financial responsibility Qualifications * 2 years Inpatient background with Hospital Nursing (Med-Surg, ER) * Well versed in Utilization Management ...
Columbus, OH · On-site
Conducts prior authorization reviews to determine financial responsibility Qualifications * 2 years Inpatient background with Hospital Nursing (Med-Surg, ER) * Well versed in Utilization Management ...
Columbus, OH · On-site
Care Review Nurse Integrated Resources, Inc., is led by a seasoned team with combined decades in ... Works with the Utilization Management team primarily responsible for inpatient medical necessity ...
New
Columbus, OH · On-site
Care Review Nurse Integrated Resources, Inc., is led by a seasoned team with combined decades in ... Works with the Utilization Management team primarily responsible for inpatient medical necessity ...
New
Columbus, OH · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care Nurses ...
Columbus, OH · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care Nurses ...
Columbus, OH · On-site
Qualifications Utilization Review in hospital setting . Prior author experience . Inpatient hospital experience . Nurses who are used to doing both production and review work . RN required . Millemen ...
Columbus, OH · On-site
Qualifications Utilization Review in hospital setting . Prior author experience . Inpatient hospital experience . Nurses who are used to doing both production and review work . RN required . Millemen ...
Columbus, OH · On-site
Qualifications • Utilization Review in hospital setting. • Prior author experience. • Inpatient hospital experience. • Nurses who are used to doing both production and review work. • RN ...
New
Columbus, OH · On-site
Qualifications • Utilization Review in hospital setting. • Prior author experience. • Inpatient hospital experience. • Nurses who are used to doing both production and review work. • RN ...
New
Columbus, OH · On-site
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... complex claim review including diagnosis-related group (DRG) validation, itemized bill review ...
Columbus, OH · On-site
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... complex claim review including diagnosis-related group (DRG) validation, itemized bill review ...
Columbus, OH · On-site
$29.05 - $56.64/hr
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... complex claim review including diagnosis-related group (DRG) validation, itemized bill review ...
Columbus, OH · On-site
$29.05 - $56.64/hr
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... complex claim review including diagnosis-related group (DRG) validation, itemized bill review ...
Resolves escalated complaints regarding utilization management and long-term services and supports ... Reviews medically appropriate clinical guidelines and other appropriate criteria with medical ...
Resolves escalated complaints regarding utilization management and long-term services and supports ... Reviews medically appropriate clinical guidelines and other appropriate criteria with medical ...
Columbus, OH · Remote
$29.05 - $56.64/hr
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... complex claim review including diagnosis-related group (DRG) validation, itemized bill review ...
Columbus, OH · Remote
$29.05 - $56.64/hr
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... complex claim review including diagnosis-related group (DRG) validation, itemized bill review ...
Columbus, OH · On-site
$24 - $32/hr
Medical
Dental
Vision
Life
Retirement
PTO
High school diploma required; associate or bachelor's degree in nursing, healthcare administration, or related field preferred * Must be 21 or older * Experience in utilization review, case ...
Columbus, OH · On-site
$24 - $32/hr
Medical
Dental
Vision
Life
Retirement
PTO
High school diploma required; associate or bachelor's degree in nursing, healthcare administration, or related field preferred * Must be 21 or older * Experience in utilization review, case ...
Columbus, OH · On-site
Medical
Dental
Vision
Life
Retirement
Job Duties Review medical records to determine appropriateness of admissions, procedures and ... affecting utilization management. PositionRequirements Bachelor's degree required. Active RN ...
Columbus, OH · On-site
Medical
Dental
Vision
Life
Retirement
Job Duties Review medical records to determine appropriateness of admissions, procedures and ... affecting utilization management. PositionRequirements Bachelor's degree required. Active RN ...
Current licensure as a registered nurse in the state of Ohio is required. * Valid Ohio driver ... Utilization review, and/or discharge planning experience desirable. Physical Requirements:
Current licensure as a registered nurse in the state of Ohio is required. * Valid Ohio driver ... Utilization review, and/or discharge planning experience desirable. Physical Requirements:
Current licensure as a registered nurse in the state of Ohio is required. * Valid Ohio driver ... Utilization review, and/or discharge planning experience desirable. Physical Requirements:
Current licensure as a registered nurse in the state of Ohio is required. * Valid Ohio driver ... Utilization review, and/or discharge planning experience desirable. Physical Requirements:
Current licensure as a registered nurse in the state of Ohio is required. * Valid Ohio driver ... Utilization review, and/or discharge planning experience desirable. Physical Requirements:
Current licensure as a registered nurse in the state of Ohio is required. * Valid Ohio driver ... Utilization review, and/or discharge planning experience desirable. Physical Requirements:
Current licensure as a registered nurse in the state of Ohio is required. * Valid Ohio driver ... Utilization review, and/or discharge planning experience desirable. Physical Requirements:
Current licensure as a registered nurse in the state of Ohio is required. * Valid Ohio driver ... Utilization review, and/or discharge planning experience desirable. Physical Requirements:
Columbus, OH · On-site
$30/hr
Utilization review, prior authorization, or managed care experience preferred. * Active OH RN Licensure * Experienced with either Interqual or Milliman Licenses/Certifications: Current RN, required.
Columbus, OH · On-site
$30/hr
Utilization review, prior authorization, or managed care experience preferred. * Active OH RN Licensure * Experienced with either Interqual or Milliman Licenses/Certifications: Current RN, required.
Columbus, OH · On-site
$85K - $95K/yr
The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...
Quick apply
Columbus, OH · On-site
$85K - $95K/yr
The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...
Columbus, OH · On-site
$85K - $95K/yr
The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...
Quick apply
Columbus, OH · On-site
$85K - $95K/yr
The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...
Columbus, OH · On-site
$85K - $95K/yr
The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...
Quick apply
Columbus, OH · On-site
$85K - $95K/yr
The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...
$20.66 - $24.84
2% of jobs
$24.84 - $29.02
9% of jobs
$31.88 is the 25th percentile. Wages below this are outliers.
$29.02 - $33.20
21% of jobs
The median wage is $36.59 / hr.
$33.20 - $37.38
23% of jobs
$37.38 - $41.56
13% of jobs
$44.81 is the 75th percentile. Wages above this are outliers.
$41.56 - $45.74
10% of jobs
$45.74 - $49.92
8% of jobs
$49.92 - $54.10
5% of jobs
$54.10 - $58.28
5% of jobs
$58.28 - $62.46
2% of jobs
$62.46 - $66.64
2% of jobs
$20
$40
$66
| Aspect | Utilization Review Rn | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, certifications in case management |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, community agencies, insurance companies |
| Primary Focus | Reviewing medical necessity and appropriateness of care | Coordinating patient care and discharge planning |
Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.
$23.76 - $51.49/hr
Other
Posted 6 days ago
8.0
Based on 199 frontline employees who took The Breakroom Quiz
163rd of 306 rated insurance
Behavioral Health Experience Required.
Seeking a Registered Nurse with a OH or compact license.
The Care Review Clinician will provide prior authorization for behavioral health services for the OH Medicaid population. Strong behavioral health care experience (Inpatient Mental Health/Psych, Substance Use Disorder, Rehabilitation/withdrawal management, outpatient BH related services etc). Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good analytical thought process is important to be successful in this role. Prefer candidates that have experience with ASAM, MCG or previous experience with Utilization Reviews.
SCHEDULE: Monday thru Friday 8:00AM to 5:00PM EST (Rotating weekends and Holiday schedules are required for this position.) Once orientation period has finished, employee may be eligible for an alternative work schedule.
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).
Behavioral health experience 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: $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
