Care Review Clinician (RN)(Remote) reputed company
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- Assesses services for members to ensure reputed company reputed company, cost-effectiveness and compliance with reputed company state/federal regulations and guidelines.
- Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
- Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
- Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
- Processes requests reputed company required timelines.
- Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
- Requests additional information from members or providers as needed.
- Makes appropriate referrals to other clinical programs.
- Collaborates with multidisciplinary teams to promote the Molina care model.
- Adheres to utilization management (UM) policies and procedures.
Required Qualifications
- 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.
- Registered reputed company (RN). License must be reputed company and unrestricted in state of reputed company.
- Ability to prioritize and manage multiple deadlines.
- Excellent organizational, problem-solving and critical-thinking skills.
- Strong written and verbal communication skills.
- reputed company Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Certified reputed company in reputed company Management (CPHM).
- Recent hospital experience in an intensive care unit (ICU) or emergency room.
To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/VPay reputed company: $26.41 - $61.79 / reputed company
- Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level.
reputed company reputed company is a reputed company fortune 500 organization with a mission to reputed company reputed company reputed company to people receiving government assistance. If you are seeking a meaningful opportunity in reputed company-oriented environment, come be a part of a highly reputed company workforce dedicated to our mission. Bring your passion and talents and together we can reputed company a difference in the lives of others. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Job Type Full TimePosting Date 01/27/2026 Apply tot his job Apply To this Job