Jacksonville, FL · Remote
$26.41 - $43/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. • ...
Jacksonville, FL · Remote
$26.41 - $43/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. • ...
Orlando, FL · Remote
$26.41 - $43/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. • ...
Orlando, FL · Remote
$26.41 - $43/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. • ...
Miami, FL · Remote
$26.41 - $43/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. • ...
Miami, FL · Remote
$26.41 - $43/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. • ...
Tampa, FL · Remote
$26.41 - $43/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. • ...
Tampa, FL · Remote
$26.41 - $43/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. • ...
Participate in quality improvement initiatives, chart audits, and performance reviews to enhance ... RN license required, depending on assignment Physical Demand & Work Environment * Fully remote/home ...
Participate in quality improvement initiatives, chart audits, and performance reviews to enhance ... RN license required, depending on assignment Physical Demand & Work Environment * Fully remote/home ...
Orlando, FL · Remote
$22 - $27/hr
Registered Nurse Trainer Employment Type: Full-Time Work Schedule: 80% Remote / 20% Travel Role Overview We are looking for a licensed RN or APRN with experience in aesthetics or med spa settings to ...
Orlando, FL · Remote
$22 - $27/hr
Registered Nurse Trainer Employment Type: Full-Time Work Schedule: 80% Remote / 20% Travel Role Overview We are looking for a licensed RN or APRN with experience in aesthetics or med spa settings to ...
Jacksonville, FL · Remote
$26.41 - $43/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. • ...
Jacksonville, FL · Remote
$26.41 - $43/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. • ...
Fort Lauderdale, FL · Remote
$26.41 - $43/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. • ...
Fort Lauderdale, FL · Remote
$26.41 - $43/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. • ...
Orlando, FL · On-site +1
$22 - $27/hr
Registered Nurse Trainer Employment Type: Full-Time Work Schedule: 80% Remote / 20% Travel Role Overview We are looking for a licensed RN or APRN with experience in aesthetics or med spa settings to ...
Orlando, FL · On-site +1
$22 - $27/hr
Registered Nurse Trainer Employment Type: Full-Time Work Schedule: 80% Remote / 20% Travel Role Overview We are looking for a licensed RN or APRN with experience in aesthetics or med spa settings to ...
Miami, FL · Remote
$26.41 - $43/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. • ...
Miami, FL · Remote
$26.41 - $43/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. • ...
Saint Petersburg, FL · Remote
$26.41 - $43/hr
... 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 ...
Saint Petersburg, FL · Remote
$26.41 - $43/hr
... 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 ...
Orlando, FL · Remote
$26.41 - $43/hr
... 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 ...
Orlando, FL · Remote
$26.41 - $43/hr
... 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 ...
Jacksonville, FL · Remote
$26.41 - $43/hr
... 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 ...
Jacksonville, FL · Remote
$26.41 - $43/hr
... 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 ...
Saint Petersburg, FL · Remote
$26.41 - $43/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. • ...
Saint Petersburg, FL · Remote
$26.41 - $43/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. • ...
Orlando, FL · Remote
$26.41 - $43/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. • ...
Orlando, FL · Remote
$26.41 - $43/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. • ...
Tampa, FL · Remote
$26.41 - $43/hr
... 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 ...
Tampa, FL · Remote
$26.41 - $43/hr
... 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 ...
Miami, FL · Remote
$26.41 - $43/hr
... 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 ...
Miami, FL · Remote
$26.41 - $43/hr
... 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 ...
Saint Petersburg, FL · Remote
$26.41 - $43/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. • ...
Saint Petersburg, FL · Remote
$26.41 - $43/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. • ...
Orlando, FL · On-site +1
$22 - $27/hr
Travel Nurse Trainer (RN/APRN) - Remote with Occasional Travel Employment Type: Full-Time | Work Schedule: 80% Remote / 20% Travel Role Overview We are seeking a licensed RN or APRN with experience ...
Orlando, FL · On-site +1
$22 - $27/hr
Travel Nurse Trainer (RN/APRN) - Remote with Occasional Travel Employment Type: Full-Time | Work Schedule: 80% Remote / 20% Travel Role Overview We are seeking a licensed RN or APRN with experience ...
Orlando, FL · Remote
$22 - $27/mo
Travel Nurse Trainer (RN/APRN) - Remote with Occasional Travel Employment Type: Full-Time | Work Schedule: 80% Remote / 20% Travel Role Overview We are seeking a licensed RN or APRN with experience ...
Orlando, FL · Remote
$22 - $27/mo
Travel Nurse Trainer (RN/APRN) - Remote with Occasional Travel Employment Type: Full-Time | Work Schedule: 80% Remote / 20% Travel Role Overview We are seeking a licensed RN or APRN with experience ...
| Aspect | Weekend Remote Rn Chart Review | Weekend Remote Lpn Chart Review |
|---|---|---|
| Credentials | Registered Nurse (RN) license | Licensed Practical Nurse (LPN) license |
| Work Environment | Remote, healthcare facilities, insurance companies | Remote, healthcare facilities, insurance companies |
| Job Responsibilities | Comprehensive chart review, clinical decision support, detailed documentation | Basic chart review, data entry, preliminary assessments |
Both roles involve remote chart review in healthcare, but RNs perform more detailed clinical assessments and have advanced licensure, while LPNs handle more basic review tasks. The RN role typically requires more clinical experience and offers broader responsibilities, making it suitable for those with RN licensure seeking remote work on weekends.
$26.41 - $43/hr
Full-time
Posted 28 days ago
8.0
Based on 192 frontline employees who took The Breakroom Quiz
144th of 263 rated insurance
JOB DESCRIPTION
Must reside in Florida
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.
#PJHS3
#LI-AC1
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: $26.41 - $43 / 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
