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Sco Um Review Rn Jobs Near Me

Molina Healthcare

Medical Review Nurse (RN)

Columbus, OH · On-site

$29.05 - $56.64/hr

... review and/or coding experience, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ...

Molina Healthcare

Medical Review Nurse (RN)

Columbus, OH · Remote

$29.05 - $56.64/hr

... review and/or coding experience, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ...

CompDrug

Registered Nurse

Columbus, OH

Registered Nurse Meaningful Nursing. Exceptional Benefits. Work-Life Balance. Looking for a nursing ... Review laboratory and toxicology results with patients. * Provide education regarding medications ...

Arbors at Oregon

Registered Nurse (RN)

Springfield, OH · On-site

Registered Nurse (RN) **Deficiency Free Survey 2026** Facility: Arbors at Springfield We invite you ... For further information, please review the Know Your Rights notice from the Department of Labor.

ComForcare

Nurse RN

Reynoldsburg, OH · On-site

$35 - $65/hr

Registered Nurse (RN) Case Manager / Compliance Nurse ComForCare Home Care - Central Ohio ... Review caregiver documentation for accuracy and compliance. * Collaborate with office staff, case ...

HCAOA

Nurse RN

Reynoldsburg, OH · On-site

$35 - $65/hr

Registered Nurse (RN) Case Manager / Compliance Nurse ComForCare Home Care is seeking a ... Review caregiver documentation for accuracy and compliance. * Collaborate with office staff, case ...

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As of Aug 13, 2026, the average hourly pay for sco um review rn in the United States is $44.48, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $51.92 per hour, depending on experience, location, and employer.

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Utilization Review Clinician (RN) - Behavioral Health

Molina Healthcare

Columbus, OH • On-site

$23.76 - $51.49/hr

Other

Posted 6 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

163rd of 306 rated insurance

Job description

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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About Molina Healthcare

Sourced by ZipRecruiter

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.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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