Inpatient Review (RN): Remote, CALIFORNIA ( 3-12 hour / night shift )
Molina Healthcare California City, California; Columbus, Georgia; Davenport, Iowa; Lincoln, Nebraska; Kenosha, Wisconsin; Salt Lake City, Utah; Ohio; Washington; Wisconsin; Tucson, Arizona; Tampa, Florida; Lexington-Fayette, Kentucky; Las Cruces, New Mexico; Spokane, Washington; West Valley City, Utah; Idaho; Kentucky; New York; Texas; Chandler, Arizona; Meridian, Idaho; Des Moines, Iowa; Cedar Rapids, Iowa; Grand Rapids, Michigan; Seattle, Washington; Rio Rancho, New Mexico; Rochester, New York; Green Bay, Wisconsin; Cincinnati, Ohio; Dallas, Texas; Orem, Utah; Georgia; Michigan; Phoenix, Arizona; Scottsdale, Arizona; Miami, Florida; St. Petersburg, Florida; Idaho Falls, Idaho; Sioux City, Iowa; Louisville, Kentucky; Santa Fe, New Mexico; Vancouver, Washington; New York, New York; Florida; Orlando, Florida; Caldwell, Idaho; Owensboro, Kentucky; Tacoma, Washington; Milwaukee, Wisconsin; Madison, Wisconsin; Dayton, Ohio; Houston, Texas; Utah; Nebraska; Savannah, Georgia; Boise, Idaho; Grand Island, Nebraska; Roswell, New Mexico; Bellevue, Washington; Provo, Utah; Iowa; Jacksonville, Florida; Macon, Georgia; Detroit, Michigan; Omaha, Nebraska; Kearney, Nebraska; Buffalo, New York; Columbus, Ohio; San Antonio, Texas; Cleveland, Ohio; Fort Worth, Texas; New Mexico; Mesa, Arizona; Nampa, Idaho; Iowa City, Iowa; Bowling Green, Kentucky; Covington, Kentucky; Warren, Michigan; Sterling Heights, Michigan; Bellevue, Nebraska; Yonkers, New York; Syracuse, New York; Racine, Wisconsin; Layton, Utah Job ID 2030024EMERGENCY ROOM ADMISSIONS REVIEW NURSE
2 openings for 12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS NON EXEMPT, 3 days a week will rotate.
TRAINING SCHEDULE WILL BE Monday thru Friday 8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift after training is completed. Training hours are mandatory.
This position supports our California Health Plan. Candidates can live anywhere in the USA if they have a valid CALIFORNIA RN license and must work the Pacific Time Zone shift hours as posted.
JOB DESCRIPTION
Job Summary
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
KNOWLEDGE/SKILLS/ABILITIES
- Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and 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 inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.
- Processes requests within required timelines.
- Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
- Requests additional information from members or providers in consistent and efficient manner.
- Makes appropriate referrals to other clinical programs.
- Collaborates with multidisciplinary teams to promote Molina Care Model.
- Adheres to UM policies and procedures.
- Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
JOB QUALIFICATIONS
Required Education
Graduate from an Accredited School of Nursing.
Required Experience
3+ years hospital acute care/medical experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
State Specific Requirements:
CA Qualifications: Licensed within the state of California
Preferred Education
Bachelor's Degree in Nursing
Preferred Experience
Previous work experience in hospital Acute care including 2 years in ER or ICU
Previous work experience with InterQual or MCG guidelines
Pay Range: $30.37 - $61.79 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 02/12/2025ABOUT OUR LOCATION
View Map- Pharmacy Technician Arizona, Cleveland Ohio, West Valley City Utah, Washington, Bellevue Washington, Kenosha Wisconsin, Bowling Green Kentucky, Warren Michigan, Kearney Nebraska, Lincoln Nebraska, Omaha Nebraska, Ohio, Houston Texas, Fort Worth Texas, Utah, Scottsdale Arizona, Miami Florida, Florida, Georgia, Davenport Iowa, Kentucky, Nebraska, Roswell New Mexico, Racine Wisconsin, Madison Wisconsin, Michigan, Bellevue Nebraska, Santa Fe New Mexico, Austin Texas, Akron Ohio, Dallas Texas, Salt Lake City Utah, San Antonio Texas, Orem Utah, Tacoma Washington, Milwaukee Wisconsin, Macon Georgia, Augusta Georgia, Sioux City Iowa, Cedar Rapids Iowa, Iowa City Iowa, Louisville Kentucky, Lexington-Fayette Kentucky, New York, Green Bay Wisconsin, Mesa Arizona, Jacksonville Florida, Nampa Idaho, Grand Island Nebraska, New Mexico, Syracuse New York, New York New York, Rochester New York, Buffalo New York, Cincinnati Ohio, Provo Utah, Layton Utah, Vancouver Washington, Tampa Florida, Atlanta Georgia, Idaho, Boise Idaho, Idaho Falls Idaho, Owensboro Kentucky, Rio Rancho New Mexico, Albuquerque New Mexico, Yonkers New York, Dayton Ohio, Texas, Wisconsin, Chandler Arizona, Tucson Arizona, Orlando Florida, Iowa, Savannah Georgia, Sterling Heights Michigan 03/20/2025
- Customer Service Representative, Medicare Pharmacy Arizona, Miami Florida, Cedar Rapids Iowa, Detroit Michigan, Ann Arbor Michigan, Nebraska, Omaha Nebraska, Grand Island Nebraska, Dayton Ohio, Houston Texas, Utah, Scottsdale Arizona, Jacksonville Florida, Sioux City Iowa, Iowa City Iowa, Louisville Kentucky, Sterling Heights Michigan, Las Cruces New Mexico, Syracuse New York, Rochester New York, Green Bay Wisconsin, Mesa Arizona, Orlando Florida, Georgia, Macon Georgia, Atlanta Georgia, Caldwell Idaho, Boise Idaho, Covington Kentucky, Kentucky, New Mexico, Yonkers New York, Cincinnati Ohio, San Antonio Texas, Salt Lake City Utah, Milwaukee Wisconsin, Racine Wisconsin, Tucson Arizona, Augusta Georgia, Savannah Georgia, Iowa, Meridian Idaho, Nampa Idaho, Grand Rapids Michigan, Kearney Nebraska, Santa Fe New Mexico, Dallas Texas, Layton Utah, Washington, Kenosha Wisconsin, Owensboro Kentucky, Michigan, Roswell New Mexico, Rio Rancho New Mexico, Akron Ohio, Fort Worth Texas, Orem Utah, West Valley City Utah, Spokane Washington, Chandler Arizona, Columbus Georgia, Davenport Iowa, Bowling Green Kentucky, Lexington-Fayette Kentucky, Albuquerque New Mexico, Cleveland Ohio, Austin Texas, Texas, Tacoma Washington, Wisconsin, Phoenix Arizona, Tampa Florida, Florida, Warren Michigan, Lincoln Nebraska, Bellevue Nebraska, New York, Columbus Ohio, Provo Utah, Bellevue Washington, Madison Wisconsin, St. Petersburg Florida, Des Moines Iowa, Idaho, Idaho Falls Idaho, Buffalo New York, Ohio, Vancouver Washington 03/11/2025
- Medical Records Collector (Must reside in NYC surrounding area) Arizona, New York New York, Queens Court New York, Lexington-Fayette Kentucky, Covington Kentucky, Grand Rapids Michigan, Rio Rancho New Mexico, New York New York, Layton Utah, Seattle Washington, Vancouver Washington, Milwaukee Wisconsin, Chandler Arizona, Jacksonville Florida, Miami Florida, Meridian Idaho, Idaho, New York, Sterling Heights Michigan, Albuquerque New Mexico, Houston Texas, Dallas Texas, Austin Texas, Fort Worth Texas, Green Bay Wisconsin, Racine Wisconsin, Georgia, Iowa City Iowa, Caldwell Idaho, Texas, Washington, Omaha Nebraska, Kearney Nebraska, Dayton Ohio, Salt Lake City Utah, Bellevue Washington, Kenosha Wisconsin, Mesa Arizona, Orlando Florida, Columbus Georgia, Nampa Idaho, Iowa, Davenport Iowa, Warren Michigan, Ann Arbor Michigan, Lincoln Nebraska, Roswell New Mexico, Buffalo New York, Rochester New York, Cincinnati Ohio, West Valley City Utah, Scottsdale Arizona, Cedar Rapids Iowa, Florida, Nebraska, New Mexico, Utah, Wisconsin, Yonkers New York, Syracuse New York, Akron Ohio, Provo Utah, Orem Utah, Tacoma Washington, Tampa Florida, Atlanta Georgia, Augusta Georgia, Savannah Georgia, Idaho Falls Idaho, Michigan, Sioux City Iowa, Owensboro Kentucky, Bellevue Nebraska, Grand Island Nebraska, Las Cruces New Mexico, Santa Fe New Mexico, Columbus Ohio, Cleveland Ohio, San Antonio Texas, Spokane Washington, St. Petersburg Florida, Boise Idaho, Des Moines Iowa, Louisville Kentucky, Bowling Green Kentucky, Detroit Michigan, Madison Wisconsin, Phoenix Arizona, Tucson Arizona, Macon Georgia, Kentucky, Ohio 02/12/2025
- Lead Data Analytics - SQL/ Databricks Arizona, Davenport Iowa, Iowa, Dallas Texas, Ohio, Spokane Washington, Tacoma Washington, Phoenix Arizona, Augusta Georgia, Nampa Idaho, Nebraska, San Antonio Texas, Salt Lake City Utah, Las Cruces New Mexico, Scottsdale Arizona, Atlanta Georgia, Owensboro Kentucky, Warren Michigan, Sterling Heights Michigan, Lincoln Nebraska, Layton Utah, Bellevue Washington, Miami Florida, Idaho Falls Idaho, Lexington-Fayette Kentucky, Columbus Ohio, Georgia, Bowling Green Kentucky, Akron Ohio, Texas, Bellevue Nebraska, Roswell New Mexico 03/05/2025