Talent.com
Care Review Clinician (RN)
Care Review Clinician (RN)Molina Healthcare • Sioux City, IA, US
No longer accepting applications
Care Review Clinician (RN)

Care Review Clinician (RN)

Molina Healthcare • Sioux City, IA, US
21 days ago
Job type
  • Full-time
Job description

Job Description

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 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.

\n

Essential Job Duties \n

\n

  • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state / federal regulations and guidelines.

\n

  • Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

    • \n

  • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and / or procedures.

    • \n

  • Conducts reviews to determine prior authorization / financial responsibility for Molina and its members.

    • \n

  • Processes requests within required timelines.

    • \n

  • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.

    • \n

  • Requests additional information from members or providers as needed.

    • \n

  • Makes appropriate referrals to other clinical programs.

    • \n

  • Collaborates with multidisciplinary teams to promote the Molina care model.

    • \n

  • Adheres to utilization management (UM) policies and procedures.

    • \n

    Required Qualifications \n

    \n

  • 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.

    • \n

  • Registered Nurse (RN). License must be active and unrestricted in state of practice.

    • \n

  • Ability to prioritize and manage multiple deadlines.

    • \n

  • Excellent organizational, problem-solving and critical-thinking skills.

    • \n

  • Strong written and verbal communication skills.

    • \n

  • Microsoft Office suite / applicable software program(s) proficiency.

    • \n

    Preferred Qualifications \n

    \n

  • Certified Professional in Healthcare Management (CPHM).

    • \n

  • Recent hospital experience in an intensive care unit (ICU) or emergency room.

    • \n To all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board.

    \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 - $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 • Sioux City, IA, US

    Related jobs
    Travel Nurse RN - ICU - Intensive Care Unit - $2,268 per week

    Travel Nurse RN - ICU - Intensive Care Unit - $2,268 per week

    GHR Healthcare - Travel Division • Sergeant Bluff, IA, US
    Permanent
    GHR Healthcare - Travel Division is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Sioux City, Iowa. Job Description & Requirements Specialty : ICU - Intensive Care U...Show more
    Last updated: 1 day ago • Promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,856 to $1,975 per week in Sioux City, IA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,856 to $1,975 per week in Sioux City, IA

    TravelNurseSource • Sioux City, IA, US
    Full-time
    TravelNurseSource is working with Fusion Medical Staffing to find a qualified ICU / Critical Care RN in Sioux City, Iowa, 51101!. Fusion Medical Staffing is seeking a ICU RN for a 13-week travel assig...Show more
    Last updated: 4 days ago • Promoted
    Travel Nurse RN - ICU - Intensive Care Unit - $2,164 per week

    Travel Nurse RN - ICU - Intensive Care Unit - $2,164 per week

    Arrow Healthcare Staffing • Sergeant Bluff, IA, US
    Full-time
    Arrow Healthcare Staffing is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Sioux City, Iowa. Job Description & Requirements Specialty : ICU - Intensive Care Unit Dis...Show more
    Last updated: 15 hours ago • Promoted • New!
    Care Review Clinician (RN)

    Care Review Clinician (RN)

    Molina Healthcare • Sioux City, IA, 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 Mond...Show more
    Last updated: 30+ days ago • Promoted
    RN Care Review Clinician Remote

    RN Care Review Clinician Remote

    Molina Healthcare • Sioux City, IA, United States
    Remote
    Full-time
    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 ...Show more
    Last updated: 15 days ago • Promoted
    RN Supervisor

    RN Supervisor

    FellowshipLIFE • Whiting, Iowa, United States, 51063
    Full-time
    Home Care Visiting RN Supervisor.FellowshipLIFE fosters a work environment grounded in integrity, inclusivity, and a genuine sense of community. We are currently seeking a Home Care Visiting RN Supe...Show more
    Last updated: 30+ days ago
    Travel Nurse RN - ICU - Intensive Care Unit - $1,426 per week

    Travel Nurse RN - ICU - Intensive Care Unit - $1,426 per week

    Arrow Healthcare Staffing • Sergeant Bluff, IA, US
    Full-time
    Arrow Healthcare Staffing is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Sioux City, Iowa. Job Description & Requirements Specialty : ICU - Intensive Care Unit Dis...Show more
    Last updated: 23 hours ago • Promoted
    Travel Nurse RN - ICU - Intensive Care Unit - $2,164 per week

    Travel Nurse RN - ICU - Intensive Care Unit - $2,164 per week

    Lucid Staffing Solutions • Sergeant Bluff, IA, US
    Full-time
    Lucid Staffing Solutions is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Sioux City, Iowa. Job Description & Requirements Specialty : ICU - Intensive Care Unit Disc...Show more
    Last updated: 15 hours ago • Promoted • New!
    Travel Nurse RN - ICU - Intensive Care Unit - $2,372 per week

    Travel Nurse RN - ICU - Intensive Care Unit - $2,372 per week

    AHS Staffing • Sergeant Bluff, IA, US
    Full-time
    AHS Staffing is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Sioux City, Iowa.Job Description & Requirements Specialty : ICU - Intensive Care Unit Discipline : RN S...Show more
    Last updated: 23 hours ago • Promoted
    Travel Nurse RN - ICU - Intensive Care Unit - $2,268 per week

    Travel Nurse RN - ICU - Intensive Care Unit - $2,268 per week

    GHR Healthcare • Sergeant Bluff, IA, US
    Permanent
    GHR Healthcare is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Sioux City, Iowa.Job Description & Requirements Specialty : ICU - Intensive Care Unit Discipline : RN...Show more
    Last updated: 1 day ago • Promoted
    RN UM Clinical Appeals Nurse Remote

    RN UM Clinical Appeals Nurse Remote

    Molina Healthcare • Sioux City, IA, United States
    Remote
    Full-time
    JOB DESCRIPTION Job Summary The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable ...Show more
    Last updated: 8 days ago • Promoted
    Travel Nurse RN - ICU - Intensive Care Unit

    Travel Nurse RN - ICU - Intensive Care Unit

    Arrow Healthcare Staffing • Sioux City, IA, US
    Full-time
    Arrow Healthcare Staffing is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Sioux City, Iowa. Job Description & Requirements.Arrow Healthcare Staffing Job ID #17...Show more
    Last updated: 30+ days ago • Promoted
    Local Contract Nurse RN - Float Long Term Care

    Local Contract Nurse RN - Float Long Term Care

    Good Samaritan Workforce Pool • Le Mars, IA, US
    Permanent
    Good Samaritan Workforce Pool is seeking a local contract nurse RN Float Long Term Care for a local contract nursing job in Le Mars, Iowa. Job Description & Requirements.Must support multiple lo...Show more
    Last updated: 3 days ago • Promoted
    Travel Nurse RN - ICU - Intensive Care Unit - $2,201 per week

    Travel Nurse RN - ICU - Intensive Care Unit - $2,201 per week

    Host Healthcare • Sergeant Bluff, IA, US
    Full-time
    Host Healthcare is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Sioux City, Iowa.Job Description & Requirements Specialty : ICU - Intensive Care Unit Discipline : R...Show more
    Last updated: 23 hours ago • Promoted
    Travel ICU RN

    Travel ICU RN

    Fusion Medical Staffing • Sioux City, IA, US
    Full-time
    Fusion Medical Staffing is seeking a ICU RN for a 13-week travel assignment in Sioux City,, Iowa.As a member of our team, you'll have the opportunity to make a positive impact on the lives of p...Show more
    Last updated: 30+ days ago • Promoted
    Travel Nurse RN - ICU - Intensive Care Unit - $2,171 per week

    Travel Nurse RN - ICU - Intensive Care Unit - $2,171 per week

    First Connect Health • Sergeant Bluff, IA, US
    Full-time
    First Connect Health is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Sioux City, Iowa. Job Description & Requirements Specialty : ICU - Intensive Care Unit Discipli...Show more
    Last updated: 6 days ago • Promoted
    Travel Nurse RN - Home Health

    Travel Nurse RN - Home Health

    Rang Healthcare • Le Mars, IA, US
    Permanent
    Rang Healthcare is seeking a travel nurse RN Home Health for a travel nursing job in Le Mars, Iowa.Job Description & Requirements. The qualified candidate will have 2 years of experience perform...Show more
    Last updated: 30+ days ago • Promoted
    Travel Nurse RN - ICU - Intensive Care Unit - $2,299 per week

    Travel Nurse RN - ICU - Intensive Care Unit - $2,299 per week

    Genie Healthcare • Sergeant Bluff, IA, US
    Full-time
    Genie Healthcare is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Sioux City, Iowa.Job Description & Requirements Specialty : ICU - Intensive Care Unit Discipline : ...Show more
    Last updated: 1 day ago • Promoted