Care Review Clinician (RN)

For this position we are seeking

a (RN) Registered Nurse who must be licensed for the state they

reside

This role will

be doing Utilization review for our Ohio Medicaid population,

looking for clinicians with strong inpatient clinical

experience

WORK

SCHEDULE : Tuesday

to Saturday – 8 AM to 5 PM

Wednesday to Sunday – 8 AM to 5

PM

Training

Schedule – Monday to Friday 8 AM to 5 PM

EST

This is a

Remote position, home office with internet connectivity of high

speed required.

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

• Assesses services for

members to ensure optimum outcomes, cost-effectiveness and

compliance with all state / federal regulations and

guidelines.

from members or providers against evidence based clinical

guidelines.

eligibility and expected length of stay for requested treatments

and / or procedures.

prior authorization / financial responsibility for Molina and its

members.

timelines.

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

manner.

members or providers as needed.

referrals to other clinical programs.

Collaborates with multidisciplinary teams to promote the Molina

care model.

(UM) policies and procedures.

Required Qualifications

least 2 years experience, including experience in hospital acute

care, inpatient review, prior authorization, managed care, or

equivalent combination of relevant education and

experience.

be active and unrestricted in state of practice.

Ability to prioritize and manage multiple

deadlines.

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).

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

geographic location, work experience, education and / or skill

level.