Talent.com
No longer accepting applications
Care Review Clinician (RN)

Care Review Clinician (RN)

Molina Healthcare CareersLincoln, NE, United States
14 days ago
Job type
  • Full-time
Job description

JOB DESCRIPTION

Job Summary

The RN Care Review Clinician 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.

The candidate must have a RN licensure and experience with medical surgical, emergency room, intensive care unit, or in a telemetry type setting.

Work Hours : Monday - Friday 8 : 00am- 5 : pm with rotational weekend and holiday coverage

Remote position

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.
  • Makes appropriate referrals to other clinical programs.
  • Collaborates with multidisciplinary teams to promote the Molina care model.
  • Adheres to utilization management (UM) policies and procedures.

Required Qualifications

  • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
  • Registered Nurse (RN). License must be active and unrestricted in state of practice.
  • Ability to prioritize and manage multiple deadlines.
  • Excellent organizational, 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).
  • Recent 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

  • Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
    • Create a job alert for this search

    Care Review Clinician Rn • Lincoln, NE, United States

    Related jobs
    • Promoted
    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,876 to $2,080 per week in Kearney, NE

    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,876 to $2,080 per week in Kearney, NE

    TravelNurseSourceLincoln, Nebraska, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in Kearney, Nebraska, 68847!. Ready to start your next travel adventure? LRS Healthcare offers a full benefi...Show moreLast updated: 14 days ago
    • Promoted
    Care Review Clinician (RN)

    Care Review Clinician (RN)

    Molina HealthcareLincoln, NE, US
    Full-time
    JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes.Responsible for verifying that services are medically necessary and align with established clini...Show moreLast updated: 23 hours ago
    • Promoted
    • New!
    RN UM Care Review Clinician Remote

    RN UM Care Review Clinician Remote

    Molina Healthcare CareersLincoln, Nebraska, United States
    Remote
    Full-time
    The RN Care Review Clinician provides support for clinical member services review assessment processes.Responsible for verifying that services are medically necessary and align with established cli...Show moreLast updated: 14 hours ago
    • Promoted
    • New!
    Medical Review Nurse (RN)

    Medical Review Nurse (RN)

    Molina Healthcare CareersLincoln, Nebraska, US
    Full-time
    JOB DESCRIPTION Looking for a RN that has a current active unrestricted license This a remote role and can sit anywhere within the United States. Work Schedule Monday to Friday - operation hours 6 A...Show moreLast updated: 15 hours ago
    • Promoted
    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $2,146 per week in Kearney, NE

    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $2,146 per week in Kearney, NE

    TravelNurseSourceLincoln, Nebraska, US
    Full-time
    TravelNurseSource is working with Prime HealthCare Staffing to find a qualified ICU / Critical Care RN in Kearney, Nebraska, 68847!. Prime HealthCare Staffing, a national health care staffing company ...Show moreLast updated: 13 days ago
    • Promoted
    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,892 to $2,098 per week in Kearney, NE

    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,892 to $2,098 per week in Kearney, NE

    TravelNurseSourceLincoln, Nebraska, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in Kearney, Nebraska, 68847!. Ready to start your next travel adventure? LRS Healthcare offers a full benefi...Show moreLast updated: 14 days ago
    • Promoted
    • New!
    RN Care Review Clinician Remote

    RN Care Review Clinician Remote

    Molina Healthcare CareersLincoln, NE, US
    Remote
    Full-time
    The RN Care Review Clinician provides support for clinical member services review assessment processes.Responsible for verifying that services are medically necessary and align with established cli...Show moreLast updated: 12 hours ago
    • Promoted
    • New!
    Care Review Clinician, PA (RN)

    Care Review Clinician, PA (RN)

    Molina Healthcare CareersLincoln, Nebraska, United States
    Full-time
    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: 14 hours ago
    • Promoted
    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $2,266 per week in Kearney, NE

    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $2,266 per week in Kearney, NE

    TravelNurseSourceLincoln, Nebraska, US
    Full-time
    TravelNurseSource is working with THP Healthcare Staffing to find a qualified ICU / Critical Care RN in Kearney, Nebraska, 68847!. Our Client is currently seeking RN - ICU positions in Kearney, NE for...Show moreLast updated: 14 days ago
    • Promoted
    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,852 to $2,139 per week in Kearney, NE

    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,852 to $2,139 per week in Kearney, NE

    TravelNurseSourceLincoln, Nebraska, US
    Full-time
    TravelNurseSource is working with National Staffing Solutions to find a qualified ICU / Critical Care RN in Kearney, Nebraska, 68848!. Details of the RN - Intensive Care Unit (ICU) opening in Kearney,...Show moreLast updated: 14 days ago
    • Promoted
    Care Review Clinician (RN)

    Care Review Clinician (RN)

    Molina Healthcare CareersLincoln, Nebraska, United States
    Full-time
    For this position we are seeking a (RN) Registered Nurse who must hold a compact license.This is a Remote position, home office with internet connectivity of high speed required.Work Schedule Monda...Show moreLast updated: 14 days ago
    Cardiovascular Clinical RN- Cardio Clinic Services

    Cardiovascular Clinical RN- Cardio Clinic Services

    Bryan HealthLincoln, Nebraska, United States, 68506
    Full-time
    Cardiovascular Clinical RN- Cardio Clinic Services.The BH Clinic RN assists physician's with examinations and procedures to serve the medical needs of patients with various cardiac related health c...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,932 to $2,129 per week in Kearney, NE

    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,932 to $2,129 per week in Kearney, NE

    TravelNurseSourceLincoln, Nebraska, US
    Full-time
    TravelNurseSource is working with AMN Healthcare to find a qualified ICU / Critical Care RN in KEARNEY, Nebraska, 68848!. Job Description & Requirements.Registered Nurse – Intensive Care - ICU - ...Show moreLast updated: 14 days ago
    • Promoted
    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,741 to $1,930 per week in Kearney, NE

    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,741 to $1,930 per week in Kearney, NE

    TravelNurseSourceLincoln, Nebraska, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in Kearney, Nebraska, 68847!. Ready to start your next travel adventure? LRS Healthcare offers a full benefi...Show moreLast updated: 14 days ago
    • Promoted
    RN Clinic Manager-Bryan Heart Cardio Clinic Services

    RN Clinic Manager-Bryan Heart Cardio Clinic Services

    Bryan HealthLincoln, NE, US
    Full-time
    Provides leadership, direction and supervision of the daily operations of assigned medical practice(s).Plans, designs, implements and maintains programs, policies and management systems of the over...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,920 to $2,114 per week in Kearney, NE

    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,920 to $2,114 per week in Kearney, NE

    TravelNurseSourceLincoln, Nebraska, US
    Full-time +2
    TravelNurseSource is working with Thrive Staffing to find a qualified ICU / Critical Care RN in Kearney, Nebraska, 68847!. Join Our Team at Thrive Staffing!.Are you a skilled ICU, RN? Thrive Staffing ...Show moreLast updated: 10 days ago
    • Promoted
    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,952 to $2,146 per week in Kearney, NE

    Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,952 to $2,146 per week in Kearney, NE

    TravelNurseSourceLincoln, Nebraska, US
    Full-time +2
    TravelNurseSource is working with Thrive Staffing to find a qualified ICU / Critical Care RN in Kearney, Nebraska, 68847!. Join Our Team at Thrive Staffing!.Are you a skilled ICU, RN? Thrive Staffing ...Show moreLast updated: 10 days ago
    • Promoted
    CRNA locum position in Lincoln, Nebraska (NE)

    CRNA locum position in Lincoln, Nebraska (NE)

    Sumo StaffingLincoln, NE, US
    Permanent
    Sumo Medical Staffing is recruiting for an experienced CRNA to work locum shifts in Lincoln, Nebraska (NE).To start as soon as credentialed, the role offers ongoing work with a competitive market r...Show moreLast updated: 26 days ago