Care Review Clinician, Inpatient (RN) - NM residencyrequired
Molina HealthcareROSWELL, NM, 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 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.
- Analyzes clinical service
requests from members or providers against evidence based clinical
guidelines.
eligibility and expected length of stay for requested treatments
and / or procedures.
authorization / financial responsibility for Molina and its members.
and presents them in a consistent and efficient manner.
needed.
programs.
promote the Molina care model.
management (UM) policies and procedures.
Required Qualifications
including experience in hospital acute care, inpatient review,
prior authorization, managed care, or equivalent combination of
relevant education and experience.
(RN). License must be active and unrestricted in state of practice.
critical-thinking skills.
communication skills.
suite / applicable software program(s) proficiency.
Preferred Qualifications
Professional in Healthcare Management (CPHM).
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 - $51.49 / HOURLY
may vary from posting based on geographic location, work
experience, education and / or skill level.
Create a job alert for this search
Clinician Inpatient • ROSWELL, NM, US
- Promoted
Care Review Clinician (RN)
Molina Healthcare CareersROSWELL, New Mexico, US- Promoted
RN
Fresenius Medical CareRoswell, NM, US- Promoted
Travel Nurse RN - ICU - Intensive Care Unit
Titan Nurse StaffingRoswell, NM, US- Promoted
- New!
RN UM Care Review Clinician Remote
Molina Healthcare CareersROSWELL, New Mexico, US- Promoted
- New!
Care Review Clinician, PA (RN)
Molina HealthcareROSWELL, NM, US- Promoted
Travel Nurse - Registered Nurse - House Supervisor - $1526.4 / Week
TRS HealthcareArtesia, NM, US- Promoted
Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,640 to $1,833 per week in Roswell, NM
TravelNurseSourceRoswell, NM, US- Promoted
Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care - $1,463 per week in Roswell, NM
TravelNurseSourceRoswell, NM, US- Promoted
Care Review Clinician, Inpatient (RN) - NM residency required
Molina Healthcare CareersROSWELL, New Mexico, US- Promoted
- New!
RN UM Care Review Clinician Remote
Molina HealthcareROSWELL, NM, US- Promoted
- New!
Care Review Clinician, Inpatient (RN) - NM residency required
Molina HealthcareRoswell, NM, US- Promoted
- New!
RN Care Review Clinician Remote
Molina HealthcareROSWELL, NM, US- Promoted
- New!
Care Review Clinician (RN)
Molina HealthcareRoswell, NM, US- Promoted
- New!
RN Care Review Clinician Remote
Molina Healthcare CareersRoswell, NM, United States- Promoted
Travel Nurse - RN - House Supervisor - $1526.4 / Week
TRS HealthcareArtesia, NM, US- Promoted
Travel Registered Nurse (RN) - Intensive Care Unit (ICU) / Critical Care in Roswell, NM
TravelNurseSourceRoswell, NM, US- Promoted
Care Review Clinician, PA (RN)
Molina Healthcare CareersROSWELL, New Mexico, US- Promoted