Care Review Clinician (RN)

JOB DESCRIPTION Job SummaryProvides 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.

eligibility and expected length of stay for requested treatments

and / or procedures.

authorization / financial responsibility for Molina and its members.

and presents them in a consistent and efficient manner.

needed.

programs.

promote the Molina care model.

management (UM) 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.

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

critical-thinking skills.

communication skills.

suite / applicable software program(s) proficiency.

Preferred Qualifications

Professional in Healthcare Management (CPHM).

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 : $26.41 - $61.79 / HOURLY

may vary from posting based on geographic location, work

experience, education and / or skill level.