Care Review Clinician, PA (RN)
Molina HealthcareLogandale, NV, US1 day ago
Job type
- Full-time
Job descriptionNevada residents preferred. Candidates who do not live in NV must work Pacific Business Hours permanently.\n\nJOB DESCRIPTION\n\nJob Summary\n\nMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.\n\nKNOWLEDGE / SKILLS / ABILITIES\n Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.\n Analyzes clinical service requests from members or providers against evidence based clinical guidelines.\n Identifies appropriate benefits and eligibility for requested treatments and / or procedures.\n Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.\n Processes requests within required timelines.\n Refers appropriate prior authorization requests to Medical Directors.\n Requests additional information from members or providers in consistent and efficient manner.\n Makes appropriate referrals to other clinical programs.\n Collaborates with multidisciplinary teams to promote Molina Care Model\n Adheres to UM policies and procedures.\n Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.\n Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.\n\nJOB QUALIFICATIONS\n\nRequired Education\n\nCompletion of an accredited Registered Nurse (RN).\n\nRequired Experience\n\n1-3 years of hospital or medical clinic experience.\n\nRequired License, Certification, Association\n\nActive, unrestricted State Registered Nursing (RN) license in good standing.\n\nPreferred Experience\n\nPrevious experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.\n\nPreferred License, Certification, Association\n\nActive, unrestricted Utilization Management Certification (CPHM).\n\nNEVADA State Specific Requirements : \n\nMust be licensed currently for the state of Nevada. Nevada is not a compact state.\n\nWORK SCHEDULE : Mon - Fri / Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.\n\nTraining will be held Mon - Fri\n\nTo all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.\n\nMolina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.\n\nPay Range : $27.73 - $59.21 / HOURLY\n Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
Create a job alert for this search
Clinician Rn • Logandale, NV, US
Related jobs Candidates who do not live in Nevada must be willing to work Pacific Business Hours.JOB DESCRIPTION\n\nJob Summary\n\nProvides support for member clinical service review processes specific to behav...Show moreLast updated: 1 day ago 
We are looking for recent graduates and experienced Class A CDL drivers in the North Las Vegas, NV area for a regional lane.
Drivers home every three weeks, hauling no touch dry van loads.Drivers on...Show moreLast updated: 30+ days ago
Remote Jobs are now available in your area.This position is a work from home position.You will not need to come into the office.
Benefits : Health Insurance, 401K, Vacation& PTO.Apply now! Work f...Show moreLast updated: 26 days ago
Responsibilities The primary responsibility of this position is to read meters and record consumption of the water used, cleaning of meter boxes, and removal of vegetation impeding access to meters...Show moreLast updated: 26 days ago
Position Summary\nCritical Care Float Pool Registered Nurses utilize a patient and family-centered approach to provide compassionate and high-quality care for children of all ages.Critical Care Flo...Show moreLast updated: 1 day ago
Current Employees : \n\nIf you are a current employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.Primary...Show moreLast updated: 1 day ago
Class A Drivers fresh out of driving school looking to start their career are being requested to apply.You will be making deliveries in 53' Dry Van Trailers running regionally from the Mississi...Show moreLast updated: 1 day ago
THE STRENGTH TO HEAL OUR NATION'S DEFENDERS.As a Certified Registered Nurse Anesthetist and officer on the U.Army health care team, you'll provide specialized care to patients requiring general ane...Show moreLast updated: 6 hours ago
Are you looking for more? Find it here.At Wells Fargo, we're more than a financial services leader - we're a global trailblazer committed to driving innovation, empowering communities, and helping ...Show moreLast updated: 6 days ago Current Employees : \n\nIf you are a current employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.Primary...Show moreLast updated: 1 day ago Candidates who do not live in NV must work Pacific Business Hours permanently.JOB DESCRIPTION\n\nJob Summary\n\nMolina Healthcare Services (HCS) works with members, providers and multidisciplinary ...Show moreLast updated: 1 day ago 
QuickMD is a leading telemedicine provider, delivering high-quality virtual care across 44 states.Since our founding in 2019, we have helped more than 100,000 patients access essential medical trea...Show moreLast updated: 30+ days ago Nevada residency required\n\nJOB DESCRIPTION\n\nJob Summary\n\nMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coor...Show moreLast updated: 1 day ago Are you looking for more? Find it here.At Wells Fargo, we're more than a financial services leader - we're a global trailblazer committed to driving innovation, empowering communities, and helping ...Show moreLast updated: 6 days ago Are you looking for more? Find it here.At Wells Fargo, we're more than a financial services leader - we're a global trailblazer committed to driving innovation, empowering communities, and helping ...Show moreLast updated: 6 days ago 
Prime Time Healthcare is seeking a travel CT Technologist for a travel job in Mesquite, Nevada.Job Description & Requirements.
Prime Time Healthcare is a leading provider of traveling healthcare pro...Show moreLast updated: 7 days ago
Prime Time Healthcare is seeking a travel CT Technologist for a travel job in Mesquite, Nevada.Job Description & Requirements.
Prime Time Healthcare is a leading provider of traveling healthcare...Show moreLast updated: 7 days ago Prime Time Healthcare is seeking a travel CT Technologist for a travel job in Mesquite, Nevada.Job Description & Requirements.
Prime Time Healthcare is a leading provider of traveling healthcare pro...Show moreLast updated: 7 days ago
- Promoted
Care Review Clinician RN / Registered Nurse BH Licensed Nevada
Molina HealthcareLittlefield, AZ, USFull-time
- Promoted
North Las Vegas NV area drivers needed, Class A CDL required, home every 3 weeks
H&H RecruitingMoapa, NV, USFull-time
- Promoted
Work From Home
Remote JobsLittlefield, AZRemote
Full-time
- Promoted
County Meter Reader
Meter ReaderLittlefield, AZFull-time
- Promoted
Clinical Nurse - Critical Care Float Pool
Phoenix Children'sLittlefield, AZ, USFull-time
- Promoted
RN - Inpatient Cardiac Unit
Monument HealthLittlefield, AZ, USFull-time
- Promoted
Class A Regional Truck Driver - CDL Graduates OK
Beast Mode TruckinMoapa Valley, NV, USFull-time
- Promoted
- New!
Certified Registered Nurse Anesthetist (CRNA) - Full-time / Part-time
United States ArmyLittlefield, AZ, USFull-time +1
- Promoted
NOW HIRING - Branch Manager North Vegas Valley District (Remote - hybrid)
WELLS FARGO BANKMESQUITE, Nevada, United States of AmericaRemote
Full-time +1
- Promoted
Infusion RN - Cancer Care Institute
Monument HealthLogandale, NV, USFull-time
- Promoted
Care Review Clinician, PA RN / Registered Nurse
Molina HealthcareLittlefield, AZ, USFull-time
- Promoted
Telemedicine Physician
QuickMDOverton, NV, USFull-time
- Promoted
Care Manager (RN)
Molina HealthcareLogandale, NV, USFull-time
- Promoted
Branch Manager North Vegas Valley District (Remote - hybrid)
WELLS FARGO BANKMESQUITE, Nevada, United States of AmericaRemote
Full-time +1
- Promoted
Wells Fargo - Branch Manager North Vegas Valley District (Remote - hybrid)
WELLS FARGO BANKMESQUITE, Nevada, United States of AmericaRemote
Full-time +1
- Promoted
Travel CT Technologist - $2,213 per week
Prime Time HealthcareMesquite, NV, United StatesFull-time
- Promoted
Travel CT Technologist
Prime Time HealthcareMesquite, NV, USFull-time
- Promoted
Travel CT Technologist - $2,276 per week
Prime Time HealthcareMesquite, NV, United StatesFull-time