Care Review Clinician (RN)

Job Description

• California residents preferred. Candidates who do not live in California must be willing to work Pacific Business Hours.

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JOB DESCRIPTION

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Job Summary

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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

Required Qualifications

Preferred Qualifications

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Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.

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CALIFORNIA State Specific Requirements :

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Must be licensed currently for the state of California. California is not a compact state.

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WORK SCHEDULE : Mon - Fri / Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.

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Training will be held Mon - Fri

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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