Care Review Clinician, Inpatient Review (RN)
Molina Healthcare Bellevue, Nebraska; New York; Rochester, New York; Vancouver, Washington; Mesa, Arizona; Jacksonville, Florida; Atlanta, Georgia; Florida; Davenport, Iowa; Caldwell, Idaho; Albuquerque, New Mexico; Santa Fe, New Mexico; Buffalo, New York; San Antonio, Texas; Orem, Utah; Georgia; Savannah, Georgia; Cedar Rapids, Iowa; Idaho; Covington, Kentucky; Rio Rancho, New Mexico; Syracuse, New York; Ohio; Cincinnati, Ohio; Houston, Texas; Texas; Layton, Utah; Salt Lake City, Utah; Bellevue, Washington; Washington; Kenosha, Wisconsin; Phoenix, Arizona; Tampa, Florida; Iowa City, Iowa; Iowa; Nampa, Idaho; Louisville, Kentucky; Ann Arbor, Michigan; New Mexico; Yonkers, New York; Provo, Utah; Fort Worth, Texas; Madison, Wisconsin; Tucson, Arizona; Miami, Florida; Orlando, Florida; Macon, Georgia; Augusta, Georgia; Meridian, Idaho; Lexington-Fayette, Kentucky; Sterling Heights, Michigan; Warren, Michigan; Detroit, Michigan; Cleveland, Ohio; Seattle, Washington; Racine, Wisconsin; Nebraska; Austin, Texas; Utah; Scottsdale, Arizona; Columbus, Georgia; Grand Rapids, Michigan; Kentucky; Grand Island, Nebraska; Omaha, Nebraska; Roswell, New Mexico; Las Cruces, New Mexico; New York, New York; Columbus, Ohio; Dayton, Ohio; West Valley City, Utah; Milwaukee, Wisconsin; Green Bay, Wisconsin; St. Petersburg, Florida; Des Moines, Iowa; Boise, Idaho; Idaho Falls, Idaho; Bowling Green, Kentucky; Michigan; Akron, Ohio; Dallas, Texas; Tacoma, Washington; Spokane, Washington; Wisconsin; Chandler, Arizona; Sioux City, Iowa; Owensboro, Kentucky; Kearney, Nebraska; Lincoln, Nebraska Job ID 2030729JOB 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.
Preferred Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
MULTI STATE / COMPACT LICENSURE
WORK SCHEDULE: Mon - Fri / Sun - Thurs / Tues - Sat with some weekends and holidays.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
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 - $51.49 / 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: 03/21/2025ABOUT OUR LOCATION
View Map- Medical Director, Behavioral Health Louisville Kentucky, Boise Idaho, Santa Fe New Mexico, Orem Utah, Seattle Washington, Bellevue Nebraska, Dayton Ohio, Columbus Ohio, Madison Wisconsin, Milwaukee Wisconsin, Idaho Falls Idaho, Sterling Heights Michigan, Vancouver Washington, Tampa Florida, Buffalo New York, Rochester New York, Bowling Green Kentucky, Lexington-Fayette Kentucky, Omaha Nebraska, Iowa City Iowa, Des Moines Iowa, Akron Ohio, Atlanta Georgia, Green Bay Wisconsin, Nampa Idaho, Phoenix Arizona, Chandler Arizona, Arizona, Texas, Nebraska, Ohio, Kentucky, Washington, Idaho, Utah, New Mexico, New York, Michigan, Iowa, Florida, Georgia, Wisconsin, Scottsdale Arizona, Provo Utah, Warren Michigan, Orlando Florida, Syracuse New York, Lincoln Nebraska, Kearney Nebraska, Tucson Arizona, Grand Rapids Michigan, Detroit Michigan, Tacoma Washington, Covington Kentucky, Cincinnati Ohio, Kenosha Wisconsin, Mesa Arizona, Davenport Iowa, Cedar Rapids Iowa, Cleveland Ohio, Savannah Georgia, Macon Georgia, Racine Wisconsin, Rio Rancho New Mexico, Roswell New Mexico, Salt Lake City Utah, Ann Arbor Michigan, St. Petersburg Florida, Yonkers New York, Sioux City Iowa, Caldwell Idaho, Columbus Georgia, Meridian Idaho, Austin Texas, San Antonio Texas, Dallas Texas, Houston Texas, Albuquerque New Mexico, Las Cruces New Mexico, West Valley City Utah, Spokane Washington, Jacksonville Florida, Miami Florida, New York New York, Grand Island Nebraska, Augusta Georgia, Fort Worth Texas, Layton Utah, Bellevue Washington, Owensboro Kentucky 04/15/2025
- Sr Program Manager, Medicare Stars Akron Ohio, Ann Arbor Michigan, Atlanta Georgia, Augusta Georgia, Florida, Georgia, Idaho, Iowa, Kentucky, Nebraska, New Mexico, Ohio, Texas, Wisconsin, Washington, New York 04/15/2025
- Senior Provider Relations Representative San Diego California 04/17/2025
- Sr Engineer - Identity and Access Management - Remote New York New York, Seattle Washington, Green Bay Wisconsin, Milwaukee Wisconsin, Racine Wisconsin, Augusta Georgia, Atlanta Georgia, Caldwell Idaho, Boise Idaho, Meridian Idaho, Covington Kentucky, Owensboro Kentucky, Roswell New Mexico, Houston Texas, Tucson Arizona, Chandler Arizona, Jacksonville Florida, Dayton Ohio, Austin Texas, Fort Worth Texas, Scottsdale Arizona, Layton Utah, Washington, Wisconsin, Savannah Georgia, Macon Georgia, Idaho, Idaho Falls Idaho, Nampa Idaho, Albuquerque New Mexico, Yonkers New York, Texas, Orem Utah, Spokane Washington, Georgia, Des Moines Iowa, Louisville Kentucky, Lexington-Fayette Kentucky, Nebraska, Omaha Nebraska, Kearney Nebraska, Buffalo New York, Syracuse New York, Dallas Texas, Utah, Tacoma Washington, Bellevue Washington, Tampa Florida, Florida, Miami Florida, Orlando Florida, Columbus Georgia, Iowa, Cedar Rapids Iowa, Iowa City Iowa, Davenport Iowa, Bowling Green Kentucky, Kentucky, Detroit Michigan, Warren Michigan, Sterling Heights Michigan, Grand Rapids Michigan, Rochester New York, San Antonio Texas, West Valley City Utah, Kenosha Wisconsin, Mesa Arizona, Michigan, Lincoln Nebraska, Santa Fe New Mexico, Ohio, Cleveland Ohio, Salt Lake City Utah, St. Petersburg Florida, Bellevue Nebraska, Grand Island Nebraska, Las Cruces New Mexico, New York, Cincinnati Ohio, Columbus Ohio, Provo Utah, Vancouver Washington, Madison Wisconsin, Phoenix Arizona, Sioux City Iowa, Ann Arbor Michigan, Rio Rancho New Mexico, New Mexico, Akron Ohio 03/12/2025