Columbus, OH · On-site
$23.76 - $51.49/hr
Behavioral Health Experience Required. Seeking a Registered Nurse with a OH or compact license. The ... Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to ...
Columbus, OH · On-site
$23.76 - $51.49/hr
Behavioral Health Experience Required. Seeking a Registered Nurse with a OH or compact license. The ... Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to ...
Logan, OH · On-site
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Logan, OH · On-site
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
Columbus, OH · On-site
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
Columbus, OH · On-site
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
Columbus, OH · On-site
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Columbus, OH · On-site
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Washington Court House, OH · On-site
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
Washington Court House, OH · On-site
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
Circleville, OH · On-site
$26.41 - $51.49/hr
Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
Circleville, OH · On-site
$26.41 - $51.49/hr
Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Circleville, OH · On-site
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
Circleville, OH · On-site
$26.41 - $51.49/hr
... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
$26.41 - $51.49/hr
Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
$26.41 - $51.49/hr
Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 ...
Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Columbus, OH · On-site
... Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Columbus, OH · On-site
... Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Columbus, OH · On-site
$29.05 - $56.64/hr
... Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Columbus, OH · On-site
$29.05 - $56.64/hr
... Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Columbus, OH · Remote
$29.05 - $56.64/hr
... Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $29.05 - $56.64 ...
Columbus, OH · Remote
$29.05 - $56.64/hr
... Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $29.05 - $56.64 ...
Columbus, OH · On-site +1
$54K - $107K/yr
Molina Healthcare of Ohio is hiring for a Sr Quality Improvement/HEDIS Specialist on our Health ... Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.
Columbus, OH · On-site +1
$54K - $107K/yr
Molina Healthcare of Ohio is hiring for a Sr Quality Improvement/HEDIS Specialist on our Health ... Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.
Molina Healthcare of Ohio is hiring for a Sr Quality Improvement/HEDIS Specialist on our Health ... Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.
Molina Healthcare of Ohio is hiring for a Sr Quality Improvement/HEDIS Specialist on our Health ... Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.
Columbus, OH · Remote
$18.25 - $24.25/hr
... nursing homes, shelters, provider offices, etc. Empowers members by helping them navigate and ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Columbus, OH · Remote
$18.25 - $24.25/hr
... nursing homes, shelters, provider offices, etc. Empowers members by helping them navigate and ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Dublin, OH · Remote
$16.40 - $31.97/hr
... homes, nursing homes, shelters, provider offices, etc. • Empowers members by helping them ... Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an ...
Dublin, OH · Remote
$16.40 - $31.97/hr
... homes, nursing homes, shelters, provider offices, etc. • Empowers members by helping them ... Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an ...
Grove City, OH · Remote
$16.40 - $31.97/hr
... nursing homes, shelters, provider offices, etc. Empowers members by helping them navigate and ... Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an ...
Grove City, OH · Remote
$16.40 - $31.97/hr
... nursing homes, shelters, provider offices, etc. Empowers members by helping them navigate and ... Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an ...
$23.76 - $51.49/hr
Other
Posted 5 days ago
8.0
Based on 199 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
