RN Care Review Clinician Critical Care Remote in WAstate

JOB DESCRIPTION

Job

Summary

The Care Review Clinician (RN) 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.

We are seeking a candidate with a WA state

RN licensure and critical care experience, i.e. ER or ICU.

Candidates with Utilization Management and med / surge experience are

highly preferred. Exceptional time management skills are needed to

be successful in this position. Further details to be discussed

during our interview process.

Remote position

preferably in Washington State.

Work schedule :

Friday- Tuesday : 8 : 00am- 5 : 00pm PST. The schedule includes 1

holiday per year

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.

clinical programs.

multidisciplinary teams to promote the Molina care

model.

policies and procedures.

Required

Qualifications

including experience in hospital acute care, inpatient review,

prior authorization, managed care, or equivalent combination of

relevant education and experience.

Nurse (RN). License must be active and unrestricted in state of

practice.

multiple deadlines.

problem-solving and critical-thinking skills.

Strong written and verbal communication skills.

Microsoft Office suite / applicable software program(s)

proficiency.

Preferred

Qualifications

Healthcare Management (CPHM).

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 : $26.41 - $59.21 / HOURLY

geographic location, work experience, education and / or skill

level.