Utilization Review Clinician (RN) - Behavioral Health
Columbus, OH · On-site
$23.76 - $51.49/hr
... Utilization Reviews ... SCHEDULE: Monday thru Friday 8:00AM to 5:00PM EST (Rotating weekends and Holiday schedules are ...
New
Columbus, OH · On-site
$23.76 - $51.49/hr
... Utilization Reviews ... SCHEDULE: Monday thru Friday 8:00AM to 5:00PM EST (Rotating weekends and Holiday schedules are ...
New
Columbus, OH · On-site
$23.76 - $51.49/hr
... Utilization Reviews ... SCHEDULE: Monday thru Friday 8:00AM to 5:00PM EST (Rotating weekends and Holiday schedules are ...
New
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... WORK ENVIRONMENT Standard office environment with occasional evenings/weekends for events. Hybrid ...
Quick apply
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... WORK ENVIRONMENT Standard office environment with occasional evenings/weekends for events. Hybrid ...
Key Responsibilities Clinical Review: * Conduct comprehensive clinical reviews of prior ... as well as weekend coverage (i.e. Wed-Sun, Thu-Mon or Fri-Tue type schedule). This will be ...
Key Responsibilities Clinical Review: * Conduct comprehensive clinical reviews of prior ... as well as weekend coverage (i.e. Wed-Sun, Thu-Mon or Fri-Tue type schedule). This will be ...
Columbus, OH · On-site
The RN Review Nurse works closely with healthcare providers, interdisciplinary teams, and non ... as well as weekend coverage (i.e. Wed-Sun, Thu-Mon or Fri-Tue type schedule). This will be ...
Columbus, OH · On-site
The RN Review Nurse works closely with healthcare providers, interdisciplinary teams, and non ... as well as weekend coverage (i.e. Wed-Sun, Thu-Mon or Fri-Tue type schedule). This will be ...
$16.25 - $20/hr
Routine intern functions are performed under the direct supervision of a pharmacist. These ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
$16.25 - $20/hr
Routine intern functions are performed under the direct supervision of a pharmacist. These ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
$16.25 - $20/hr
Routine intern functions are performed under the direct supervision of a pharmacist. These ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
$16.25 - $20/hr
Routine intern functions are performed under the direct supervision of a pharmacist. These ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
$16.25 - $20/hr
Routine intern functions are performed under the direct supervision of a pharmacist. These ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
$16.25 - $20/hr
Routine intern functions are performed under the direct supervision of a pharmacist. These ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
Grove City, OH · On-site
$15.75 - $19.50/hr
Pharmacy Intern (PRN/Casual) Are you a pharmacy student eager to gain valuable hands-on experience ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
Grove City, OH · On-site
$15.75 - $19.50/hr
Pharmacy Intern (PRN/Casual) Are you a pharmacy student eager to gain valuable hands-on experience ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
Routine intern functions are performed under the direct supervision of a pharmacist. These ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
Routine intern functions are performed under the direct supervision of a pharmacist. These ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
$15.75 - $19.50/hr
Routine intern functions are performed under the direct supervision of a pharmacist. These ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
$15.75 - $19.50/hr
Routine intern functions are performed under the direct supervision of a pharmacist. These ... reviews, renal dosing, medication utilization reviews, patient rounds with physicians ...
Springfield, OH · On-site
$15.75 - $19.50/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Springfield, OH · On-site
$15.75 - $19.50/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Columbus, OH · On-site
$15.75 - $19.50/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Columbus, OH · On-site
$15.75 - $19.50/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Johnstown, OH · On-site
$16.25 - $20/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Johnstown, OH · On-site
$16.25 - $20/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Lancaster, OH · On-site
$15.25 - $19/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Lancaster, OH · On-site
$15.25 - $19/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Grove City, OH · On-site
$15.75 - $19.50/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Grove City, OH · On-site
$15.75 - $19.50/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Newark, OH · On-site
$15.50 - $19/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Newark, OH · On-site
$15.50 - $19/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Hilliard, OH · On-site
$15.75 - $19.50/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Hilliard, OH · On-site
$15.75 - $19.50/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Pickerington, OH · On-site
$14.75 - $18.25/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Pickerington, OH · On-site
$14.75 - $18.25/hr
Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
$15.75 - $19.50/hr
As a Graduate Pharmacy Intern, you will apply your didactic learning from pharmacy school and ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
$15.75 - $19.50/hr
As a Graduate Pharmacy Intern, you will apply your didactic learning from pharmacy school and ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Grove City, OH · On-site
$15.75 - $19.50/hr
As a Graduate Pharmacy Intern, you will apply your didactic learning from pharmacy school and ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
Grove City, OH · On-site
$15.75 - $19.50/hr
As a Graduate Pharmacy Intern, you will apply your didactic learning from pharmacy school and ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...
$9.13 - $10.38
1% of jobs
$10.38 - $11.63
0% of jobs
$11.63 - $12.87
3% of jobs
$12.87 - $14.12
11% of jobs
$14.49 is the 25th percentile. Wages below this are outliers.
$14.12 - $15.36
35% of jobs
The median wage is $15.41 / hr.
$15.36 - $16.61
13% of jobs
$17.78 is the 75th percentile. Wages above this are outliers.
$16.61 - $17.85
14% of jobs
$17.85 - $19.10
11% of jobs
$19.10 - $20.35
12% of jobs
$20.35 - $21.59
1% of jobs
$21.59 - $22.84
1% of jobs
$9
$16
$22

$23.76 - $51.49/hr
Other
Posted 3 days ago
New
8.0
Based on 198 frontline employees who took The Breakroom Quiz
163rd of 304 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