Remote Care Review Clinician, Inpatient Review (RN) - TX ONLY
About the position
The Utilization Review RN position at Molina Healthcare involves joining the inpatient review team to conduct initial and concurrent reviews, with opportunities for cross-training in prior authorization reviews. The role focuses on assessing and coordinating care for members with high needs, ensuring compliance with regulations, and promoting cost-effective healthcare delivery.
- Responsibilities
- Conduct initial and concurrent reviews of inpatient services to ensure optimum outcomes and compliance with regulations.
- Analyze clinical service requests against evidence-based clinical guidelines.
- Identify appropriate benefits, eligibility, and expected length of stay for requested treatments or procedures.
- Process requests within required timelines and refer cases to Medical Directors as necessary.
- Collaborate with multidisciplinary teams to promote the Molina Care Model.
- Request additional information from members or providers efficiently.
- Perform prior authorization reviews and related duties as needed.
- Requirements
- Graduate from an Accredited School of Nursing.
- 3+ years of hospital acute care/medical experience.
- Active, unrestricted State Registered Nursing (RN) license in good standing.
- Valid driver's license with a good driving record.
- Nice-to-haves
- Bachelor's Degree in Nursing
- Recent hospital experience in ICU, Medical, or ER unit.
- Active, unrestricted Utilization Management Certification (CPHM).
- Benefits
- Competitive benefits and compensation package.
Apply Now
Apply Now