Care Review Clinician (RN) - Remote Opportunity (PST Time Zone)
Job Summary
Molina Healthcare Services (HCS) is seeking a skilled Care Review Clinician to join our team of dedicated professionals. As a Care Review Clinician, you will play a vital role in assessing, facilitating, planning, and coordinating integrated care delivery across the continuum, including behavioral health and long-term care, for members with high need potential. Our team works collaboratively to ensure patients receive quality care that is medically appropriate and cost-effective, based on the severity of illness and site of service.
Key Responsibilities
- Conduct comprehensive assessments to ensure optimal outcomes, cost-effectiveness, and compliance with state and federal regulations and guidelines.
- Analyze clinical service requests against evidence-based clinical guidelines to determine medical necessity and identify appropriate benefits and eligibility.
- Perform prior authorization reviews to determine financial responsibility for Molina Healthcare and its members, and process requests within required timelines.
- Collaborate with multidisciplinary teams to promote the Molina Care Model and adhere to Utilization Management (UM) policies and procedures.
- Make referrals to other clinical programs and request additional information from members or providers in a consistent and efficient manner.
Requirements
- Completion of an accredited Registered Nurse (RN) program.
- 1-3 years of hospital or medical clinic experience.
- Active, unrestricted State Registered Nursing (RN) license in good standing.
What We Offer
Molina Healthcare provides a competitive benefits and compensation package, with an hourly pay range of $26.41 - $61.79. Actual compensation may vary based on geographic location, work experience, education, and/or skill level. We are an Equal Opportunity Employer (EOE) M/F/D/V.
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