Care Review Clinician, PA (RN)
Molina HealthcareTampa, FL, US30+ days ago
Job type
- Full-time
Job descriptionAnalyzes clinical service requests from members or providers against evidence based clinical guidelines. Identifies appropriate benefits and eligibility for requested treatments and / or procedures. Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members. Processes requests within required timelines. Refers appropriate prior authorization requests to Medical Directors. Requests additional information from members or providers in consistent and efficient manner. Makes appropriate referrals to other clinical programs. Collaborates with multidisciplinary teams to promote Molina Care Model Adheres to UM policies and procedures. Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan. Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings. Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
Job Description
JOB DESCRIPTION
\n
Job Summary
\n
Molina 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
KNOWLEDGE / SKILLS / ABILITIES
\n \n
- Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n \n
JOB QUALIFICATIONS
\n
Required Education
\n
Completion of an accredited Registered Nurse (RN).
\n
Required Experience
\n
1-3 years of hospital or medical clinic experience.
\n
Required License, Certification, Association
\n
Active, unrestricted State Registered Nursing (RN) license in good standing.
\n
\n
\n
Preferred Experience
\n
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.
\n
\n
\n
Preferred License, Certification, Association
\n
Active, unrestricted Utilization Management Certification (CPHM).
\n
\n
MULTI STATE / COMPACT LICENSURE
\n
Individual state licensures which are not part of the compact states are required for : CA, NV, IL, and MI
\n
\n
WORK SCHEDULE : Sun - Thurs / Tues - Sat shift will rotate with some holidays.
\n
Training will be held Mon - Fri
\n
\n
To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.
\n
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 - $51.49 / HOURLY
Create a job alert for this search
Clinician Rn • Tampa, FL, US
Related jobs
Are you looking for a place to deliver excellent care patients deserve? At HCA Florida Bayonet Point Hospital we support our colleagues in their positions.
Join our Team as a(an) RN Rapid Response a...Show moreLast updated: 6 days ago
Are you looking to make a difference in patients' lives with a company that values your expertise? Join us in our mission of delivering compassionate healthcare where it matters most at home.Pinna...Show moreLast updated: 20 hours ago
HCA Florida Bayonet Point Hospital is committed to investing in the latest technology enabling nurses to work more efficiently.
Are you passionate about delivering patient-centered care?.Submit your...Show moreLast updated: 4 days ago
Are you looking to make a difference in patients lives with a company that values your expertise Join us in our mission of delivering compassionate healthcare where it matters most at home.Pinnacl...Show moreLast updated: 1 day ago
Description Introduction Up to $15,000 sign-on bonus available for eligible candidates Are you looking for a place to deliver excellent care patients deserve? At HCA Florida Largo Hospital we suppo...Show moreLast updated: 28 days ago
Description Join Our Life-Saving Team at HCA Florida Bayonet Point Hospital in Hudson, Florida! Are you an experienced Registered Nurse (RN) with a passion for making a difference in the lives of c...Show moreLast updated: 4 hours ago
Are you looking for a place to deliver excellent care patients deserve? At HCA Florida Bayonet Point Hospital we support our colleagues in their positions.
Join our Team as a(an) RN CVOR and access ...Show moreLast updated: 30+ days ago
Wonderful OB only CRNA Opportunity in Lakeland, FL.We offer an exceptional compensation package.Health and wellness benefit options.
The benefits package includes medical, dental and vision, life an...Show moreLast updated: 30+ days ago Do you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.
HCA Florida Bayonet Point Hospital have the opportunity to make a real i...Show moreLast updated: 4 days ago 
Description Introduction Do you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients.
At HCA Florida Blake Hospital our nurses set us apart fr...Show moreLast updated: 4 hours ago Description Introduction HCA Florida Bayonet Point Hospital is committed to investing in the latest technology enabling nurses to work more efficiently.
Are you passionate about delivering patient-c...Show moreLast updated: 4 hours ago 
Do you have the career opportunities as a RN Critical Care Float Pool you want in your current role? We invest in what matters most to nurses like you – at home, at work, and at every stage i...Show moreLast updated: 30+ days ago Are you looking to make a difference in patients lives with a company that values your expertise Join us in our mission of delivering compassionate healthcare where it matters most at home.Pinnacl...Show moreLast updated: 8 days ago 
Up to $15,000 sign-on bonus available for eligible candidates.Do you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients.At HCA Florida Larg...Show moreLast updated: 30+ days ago Molina 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, inc...Show moreLast updated: 30+ days ago JOB DESCRIPTION Job Summary \n.Provides support for clinical member services review assessment processes.Responsible for verifying that services are medically necessary and align with established c...Show moreLast updated: 21 days ago Description Introduction Are you looking for a place to deliver excellent care patients deserve? At HCA Florida Bayonet Point Hospital we support our colleagues in their positions.Join our Team as ...Show moreLast updated: 4 hours ago Description Introduction Do you have the career opportunities as a RN Clinical Nurse Coordinator Med Surg you want in your current role? We invest in what matters most to nurses like you – at home,...Show moreLast updated: 11 days ago
- Promoted
RN Rapid Response
HCA Florida Bayonet Point HospitalHudson, FL, USFull-time +2
- Promoted
- New!
Clinical Manager RN - Remote
Pinnacle Home CareTarpon Springs, FL, USRemote
Full-time
- Promoted
RN PACU
HCA Florida Bayonet Point HospitalHudson, FL, USFull-time +1
- Promoted
Clinical Manager RN
Pinnacle CareerOldsmar, Florida, USAFull-time
- Promoted
RN Registered Nurse PCU IMC
HCA Florida Largo HospitalLargo, FL, United StatesFull-time +1
- Promoted
- New!
RN Openings-HCA Florida Bayonet Point Hospital
HCA Florida Bayonet Point HospitalPort Richey, FL, United StatesFull-time
- Promoted
RN CVOR
HCA Florida Bayonet Point HospitalHudson, FL, USFull-time +1
- Promoted
CRNA - Anesthesiology-Obstetric job available in Lakeland, Florida
InSync Healthcare RecruitersLakeland, FL, USFull-time
- Promoted
RN PACU Post Anesthesia Care
HCA Florida Bayonet Point HospitalHudson, FL, USFull-time +1
- Promoted
- New!
Registered Nurse RN Critical Care Float Pool
HCA Florida Blake HospitalWest Bradenton, FL, United StatesFull-time +1
- Promoted
- New!
RN Cardiac PCU
HCA Florida Bayonet Point HospitalPort Richey, FL, United StatesFull-time +1
- Promoted
RN Critical Care Float Pool
HCA Florida South Tampa HospitalClearwater, FL, USFull-time +1
- Promoted
Clinical Review Specialist
Pinnacle CareerOldsmar, Florida, USAFull-time
- Promoted
RN Clinical Nurse Coordinator Progressive Care
HCA Florida Largo HospitalLargo, FL, USFull-time +1
- Promoted
Care Review Clinician, PA (RN)
Molina HealthcareSaint Petersburg, FL, USFull-time
- Promoted
Care Review Clinician (RN)
Molina HealthcareSaint Petersburg, FL, USFull-time
- Promoted
- New!
RN Charge Clin Coordinator Cardiac PCU
HCA Florida Bayonet Point HospitalPort Richey, FL, United StatesFull-time +1
- Promoted
RN Clinical Nurse Coordinator Med Surg
HCA Florida Largo HospitalLargo, FL, United StatesFull-time