Care Review Clinician, PA (RN)Molina Healthcare Careers • Meridian, ID, United States
No longer accepting applications
Care Review Clinician, PA (RN)
Molina Healthcare Careers • Meridian, ID, United States
19 hours ago
Job type
- Full-time
Job descriptionNevada residents preferred. Candidates who do not live in NV must work Pacific Business Hours permanently. JOB DESCRIPTION Job Summary 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. KNOWLEDGE / SKILLS / ABILITIES Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Analyzes 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. JOB QUALIFICATIONS Required Education Completion of an accredited Registered Nurse (RN). Required Experience 1-3 years of hospital or medical clinic experience. Required License, Certification, Association Active, unrestricted State Registered Nursing (RN) license in good standing. Preferred Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. Preferred License, Certification, Association Active, unrestricted Utilization Management Certification (CPHM). NEVADA State Specific Requirements : Must be licensed currently for the state of Nevada. Nevada is not a compact state. WORK SCHEDULE : Mon - Fri / Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays. Training will be held Mon - Fri To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. Pay Range : $27.73 - $59.21 / 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
Clinician Rn • Meridian, ID, United States
Related jobs
Nampa, Idaho\n\nStart : ASAP\n\n12 hour mids\n\n36 hours, 13 weeks\n\n$1,680 / wk est\n\n1413689\n\nAtlas Medstaff is currently seeking candidates in the ER profession for a 13 week contract in the Na...Show more
TravelNurseSource is working with Fusion Medical Staffing to find a qualified ICU / Critical Care RN in Boise, Idaho, 83712!\n\nPay Information\n$2,252 to $2,396 per week\n\nAbout The Position\nTrave...Show more
DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show more
Provides support for clinical member services review assessment processes.Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance p...Show more
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 more
Description Hourly Wage Estimate : $38.Learn More About The benefits Offered For This Job.The estimate displayed represents the typical wage range of candidates hired.
Factors that may be used to det...Show more Candidates who do not live in Nevada must be willing to work Pacific Business Hours.JOB DESCRIPTION\n\nJob Summary\n\nProvides support for member clinical service review processes specific to behav...Show more 
Employment Type Part time Shift Day Shift Description At Saint Alphonsus Health System, we are looking for people who are living out their calling.
We want you to be passionate about coming to work,...Show more JOB DESCRIPTION\n\nJob Summary\n\nMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery...Show more DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show more 
We are seeking a dedicated RN - Oncology in Kuna, ID, offering $2,243 / week.Responsibilities\n • Provide comprehensive nursing care to oncology patients, including assessments, treatments, and sympto...Show more DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show more 
Provide specialized nursing care in a Pediatric Intensive Care Unit (PICU) setting, delivering critical support to young patients and their families.
This contract opportunity is ideal for registere...Show more
Description\n\nRN Coordinator- Providence Home Services- Oregon\n\nSchedule : Full Time / Days\n\nRN Coordinator role consists of the planning and coordination of new referrals.The position will also ...Show more DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show more DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show more DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show more DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show more DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show more DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show more
RN : ER
Atlas MedStaff • Nampa, ID, US
Full-time
Last updated: 1 day ago • Promoted
Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,252 to $2,396 per week in Boise, ID
Travel Nurse Source • Eagle, ID, US
Full-time
Last updated: 1 day ago • Promoted
Delivery Driver - Flexible Onboarding
DoorDash • Letha, ID, United States
Full-time +1
Last updated: 30+ days ago • Promoted
Care Review Clinician (RN)
Molina Healthcare • BOISE, US
Permanent
Last updated: 22 hours ago • Promoted • New!
Care Review Clinician, Inpatient Review (RN) - Full-time
Molina Healthcare • Eagle, ID, US
Full-time
Last updated: 1 day ago • Promoted
RN Clinical Coordinator Behavioral Health Days
West Valley Medical Center • Caldwell, ID, United States
Full-time +1
Last updated: 19 hours ago • Promoted • New!
Care Review Clinician RN (BH Licensed) Nevada
Molina Healthcare • Caldwell, ID, US
Full-time
Last updated: 1 day ago • Promoted
RN Ten Mile Urgent Care Clinic Part Time Days
Trinity Health • Nampa, ID, United States
Part-time
Last updated: 23 hours ago • Promoted
Care Review Clinician, PA (RN)
Molina Healthcare • Garden City, ID, US
Full-time
Last updated: 1 day ago • Promoted
Restaurant Delivery - Start Earning Quickly
DoorDash • New Plymouth, ID, United States
Full-time +1
Last updated: 30+ days ago • Promoted
RN - Oncology
Life Time • Kuna, ID, US
Full-time
Last updated: 1 day ago • Promoted
Restaurant Delivery - Flexible Onboarding
DoorDash • Letha, ID, United States
Full-time +1
Last updated: 30+ days ago • Promoted
Pediatric Intensive Care RN - Caldwell, Idaho
Soliant Health • Caldwell, ID, US
Full-time
Last updated: 1 day ago • Promoted
RN Coordinator - Infusion
Providence • Eagle, ID, US
Full-time
Last updated: 1 day ago • Promoted
Restaurant Delivery
DoorDash • New Plymouth, ID, United States
Full-time +1
Last updated: 30+ days ago • Promoted
Restaurant Delivery - Onboarding / Onboard
DoorDash • Letha, ID, United States
Full-time +1
Last updated: 30+ days ago • Promoted
Restaurant Delivery - Sign Up and Start Earning
DoorDash • New Plymouth, ID, United States
Full-time +1
Last updated: 30+ days ago • Promoted
Restaurant Delivery - Receive 100% of Customer Tips
DoorDash • New Plymouth, ID, United States
Full-time +1
Last updated: 30+ days ago • Promoted
Restaurant Delivery - Sign Up in Minutes
DoorDash • New Plymouth, ID, United States
Full-time +1
Last updated: 30+ days ago • Promoted
Delivery Driver - Sign Up and Start Earning
DoorDash • Letha, ID, United States
Full-time +1
Last updated: 30+ days ago • Promoted