Care Review Clinician (RN) NIGHT SHIFT

• California residents

preferred.

EMERGENCY ROOM ADMISSIONS REVIEW

NURSE

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3-12 NIGHT

SHIFT 7 : 30PM  - 08 : 30AM PACIFIC HOURS NON EXEMPT, 3 days a

week will rotate.

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TRAINING SCHEDULE WILL

BE  Monday thru Friday  8 : 30AM to 5 : 30PM PACIFIC

throughout a 2 - 3 month training and then will move to a 3 day / 12

hour shift after training is completed. Training hours are

mandatory.

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This

position supports our California Health Plan. Candidates can live

anywhere in the USA if they have

a valid CALIFORNIA RN license and must work  the

Pacific Time Zone shift hours as

posted.

JOB

DESCRIPTION

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

for members to ensure optimum outcomes, cost-effectiveness and

compliance with all state / federal regulations and

guidelines.

members or providers against evidence based clinical

guidelines.

eligibility and expected length of stay for requested treatments

and / or procedures.

authorization / financial responsibility for Molina and its

members.

timelines.

directors (MDs) and presents them in a consistent and efficient

manner.

providers as needed.

other clinical programs.

multidisciplinary teams to promote the Molina care model.

procedures.

Required

Qualifications

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.

multiple deadlines.

problem-solving and critical-thinking skills.

written and verbal communication skills.

Office suite / applicable software program(s) proficiency.

Preferred Qualifications

Healthcare Management (CPHM).

Recent hospital experience in an intensive care unit (ICU) or

emergency room.

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 : $30.37 - $59.21

/ HOURLY

on geographic location, work experience, education and / or skill

level.