Supv, Care Review (RN)
Molina Healthcare Bellevue, Nebraska; Rio Rancho, New Mexico; Buffalo, New York; Rochester, New York; Yonkers, New York; Houston, Texas; Spokane, Washington; Tacoma, Washington; Scottsdale, Arizona; Phoenix, Arizona; Mesa, Arizona; Augusta, Georgia; Cedar Rapids, Iowa; Louisville, Kentucky; Detroit, Michigan; Grand Island, Nebraska; Santa Fe, New Mexico; New York; Cleveland, Ohio; Austin, Texas; Provo, Utah; Orem, Utah; Racine, Wisconsin; Tucson, Arizona; St. Petersburg, Florida; Nampa, Idaho; Las Cruces, New Mexico; New York, New York; West Valley City, Utah; Jacksonville, Florida; Orlando, Florida; Columbus, Georgia; Iowa; Bowling Green, Kentucky; Kearney, Nebraska; Albuquerque, New Mexico; Syracuse, New York; Cincinnati, Ohio; Fort Worth, Texas; Salt Lake City, Utah; Bellevue, Washington; Green Bay, Wisconsin; Madison, Wisconsin; Miami, Florida; Des Moines, Iowa; Meridian, Idaho; Ann Arbor, Michigan; Lincoln, Nebraska; Omaha, Nebraska; Dayton, Ohio; Ohio; Dallas, Texas; Layton, Utah; Kenosha, Wisconsin; Chandler, Arizona; Tampa, Florida; Atlanta, Georgia; Iowa City, Iowa; Owensboro, Kentucky; Sterling Heights, Michigan; Nebraska; Roswell, New Mexico; New Mexico; Akron, Ohio; Columbus, Ohio; Savannah, Georgia; Sioux City, Iowa; Idaho; Boise, Idaho; Kentucky; Warren, Michigan; Vancouver, Washington; Washington; Milwaukee, Wisconsin; Wisconsin; Florida; Georgia; Macon, Georgia; Davenport, Iowa; Idaho Falls, Idaho; Covington, Kentucky; Michigan; San Antonio, Texas; Utah; Seattle, Washington; Caldwell, Idaho; Lexington-Fayette, Kentucky; Grand Rapids, Michigan; Texas Job ID 2030660***Residents in CENTRAL Time Zone preferred. Candidates who do not live in Central Time zone must work CENTRAL DAYTIME BUSINESS HOURS.
Work Schedule: 4 days a week - 10hrs a day. Schedule will be alternating every 4 weeks Monday-Thursday and Wed - Saturday.
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
- Oversees an integrated Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review, and/or other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time.
- Functions as a hands-on supervisor, coordinating and monitoring clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.
- Manages and evaluates team members in the performance of various utilization management activities; provides coaching, counseling, employee development, and recognition; and assists with selection, orientation and mentoring of new staff.
- Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care including Behavioral Health and Long-Term Care for Molina members.
- Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
- Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.
- Completes staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines.
- Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement.
JOB QUALIFICATIONS
Required Education
Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.
Required Experience
- 3+ years clinical nursing experience.
- 2+ years utilization management experience.
- Experience demonstrating leadership skills.
Required License, Certification, Association
- Active, unrestricted State Registered Nursing (RN) 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 Education
Bachelor's or Master's Degree in Nursing, Health Care Administration, Public Health or related field.
Preferred Experience
- 5 years clinical practice with managed care, hospital nursing or utilization management experience.
- 3+ years supervisory experience in a managed healthcare environment.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM), Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification.
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: $66,456 - $129,590 / ANNUAL
*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- Dir, Reporting & Analytics - Databricks/SQL/Power BI - Remote Sterling Heights Michigan, Nebraska, Ann Arbor Michigan, Omaha Nebraska, Ohio, Orem Utah, Tacoma Washington, Green Bay Wisconsin, Racine Wisconsin, Kentucky, Grand Island Nebraska, Kearney Nebraska, New York New York, Buffalo New York, West Valley City Utah, Kenosha Wisconsin, Atlanta Georgia, Sioux City Iowa, Bowling Green Kentucky, Lexington-Fayette Kentucky, Michigan, Grand Rapids Michigan, Albuquerque New Mexico, Rio Rancho New Mexico, Santa Fe New Mexico, Columbus Ohio, Layton Utah, Seattle Washington, Vancouver Washington, Mesa Arizona, St. Petersburg Florida, Des Moines Iowa, Iowa, Owensboro Kentucky, Louisville Kentucky, Las Cruces New Mexico, Syracuse New York, Akron Ohio, Houston Texas, Austin Texas, San Antonio Texas, Provo Utah, Spokane Washington, Caldwell Idaho, Warren Michigan, Roswell New Mexico, Cleveland Ohio, Dayton Ohio, Fort Worth Texas, Utah, Tucson Arizona, Florida, Georgia, Iowa City Iowa, Idaho, Detroit Michigan, Bellevue Nebraska, New York, Texas, Milwaukee Wisconsin, Chandler Arizona, Miami Florida, Tampa Florida, Columbus Georgia, Cedar Rapids Iowa, Idaho Falls Idaho, Boise Idaho, Meridian Idaho, Covington Kentucky, Rochester New York, Dallas Texas, Salt Lake City Utah, Wisconsin, Scottsdale Arizona, Macon Georgia, Augusta Georgia, Davenport Iowa, Lincoln Nebraska, New Mexico, Yonkers New York, Cincinnati Ohio, Bellevue Washington, Washington, Madison Wisconsin, Phoenix Arizona, Orlando Florida, Jacksonville Florida, Savannah Georgia, Nampa Idaho 03/28/2025
- Medical Claim Review Nurse (RN) Remote IL & WI Scottsdale Arizona, St. Petersburg Florida, Caldwell Idaho, Grand Rapids Michigan, New York, New York New York, Yonkers New York, Cleveland Ohio, Columbus Ohio, Tucson Arizona, Jacksonville Florida, Tampa Florida, Des Moines Iowa, Boise Idaho, Austin Texas, Texas, Fort Worth Texas, Madison Wisconsin, Atlanta Georgia, Macon Georgia, Sioux City Iowa, Lexington-Fayette Kentucky, Michigan, Grand Island Nebraska, Las Cruces New Mexico, Albuquerque New Mexico, Syracuse New York, Provo Utah, Salt Lake City Utah, Spokane Washington, Washington, Milwaukee Wisconsin, Wisconsin, Iowa, Iowa City Iowa, Bowling Green Kentucky, Kentucky, Omaha Nebraska, Nebraska, San Antonio Texas, Houston Texas, Bellevue Washington, Tacoma Washington, Green Bay Wisconsin, Orlando Florida, Miami Florida, Georgia, Davenport Iowa, Nampa Idaho, Idaho, Louisville Kentucky, Sterling Heights Michigan, Warren Michigan, Rio Rancho New Mexico, Roswell New Mexico, New Mexico, Vancouver Washington, Seattle Washington, Phoenix Arizona, Cedar Rapids Iowa, Meridian Idaho, Owensboro Kentucky, Detroit Michigan, Lincoln Nebraska, Buffalo New York, Akron Ohio, Ohio, Orem Utah, Utah, Mesa Arizona, Chandler Arizona, Ann Arbor Michigan, Kearney Nebraska, Rochester New York, Dayton Ohio, Dallas Texas, West Valley City Utah, Racine Wisconsin, Florida, Columbus Georgia, Savannah Georgia, Augusta Georgia, Idaho Falls Idaho, Covington Kentucky, Bellevue Nebraska, Santa Fe New Mexico, Cincinnati Ohio, Layton Utah, Kenosha Wisconsin 03/28/2025
- Pharmacy Technician (Must be state licensed and nationally certified) Sioux City Iowa, Caldwell Idaho, Idaho Falls Idaho, Owensboro Kentucky, Sterling Heights Michigan, Nebraska, Yonkers New York, New York, San Antonio Texas, Seattle Washington, Tacoma Washington, Chandler Arizona, Savannah Georgia, Iowa City Iowa, Davenport Iowa, Meridian Idaho, Boise Idaho, Kearney Nebraska, Bellevue Nebraska, Albuquerque New Mexico, Syracuse New York, Cincinnati Ohio, Dayton Ohio, Akron Ohio, Provo Utah, Utah, Layton Utah, Bellevue Washington, Florida, Miami Florida, Augusta Georgia, Lexington-Fayette Kentucky, Grand Rapids Michigan, New Mexico, Columbus Ohio, Salt Lake City Utah, Kenosha Wisconsin, Mesa Arizona, Scottsdale Arizona, Jacksonville Florida, Georgia, Cedar Rapids Iowa, Covington Kentucky, Lincoln Nebraska, Ohio, Austin Texas, Dallas Texas, Washington, Tampa Florida, Atlanta Georgia, Macon Georgia, Columbus Georgia, Des Moines Iowa, Grand Island Nebraska, Detroit Michigan, Las Cruces New Mexico, Rochester New York, Buffalo New York, New York New York, Fort Worth Texas, Green Bay Wisconsin, Orem Utah, Spokane Washington, Vancouver Washington, Tucson Arizona, St. Petersburg Florida, Idaho, Nampa Idaho, Rio Rancho New Mexico, Cleveland Ohio, Wisconsin, Racine Wisconsin, Milwaukee Wisconsin, Iowa, Bowling Green Kentucky, Kentucky, Warren Michigan, Ann Arbor Michigan, Texas, Houston Texas, West Valley City Utah, Madison Wisconsin, Phoenix Arizona, Orlando Florida, Michigan, Louisville Kentucky, Omaha Nebraska, Santa Fe New Mexico, Roswell New Mexico 03/20/2025
- Sr Actuarial Analyst (Medicare) - REMOTE Bellevue Nebraska, Yonkers New York, Cleveland Ohio, Ohio, Houston Texas, Spokane Washington, Macon Georgia, Des Moines Iowa, Davenport Iowa, Boise Idaho, Idaho Falls Idaho, Kentucky, Detroit Michigan, Omaha Nebraska, New Mexico, Rio Rancho New Mexico, Syracuse New York, Cincinnati Ohio, Provo Utah, Scottsdale Arizona, Orlando Florida, Nampa Idaho, Owensboro Kentucky, Louisville Kentucky, Bowling Green Kentucky, Warren Michigan, Sterling Heights Michigan, Santa Fe New Mexico, Roswell New Mexico, Tucson Arizona, Iowa, Meridian Idaho, Lexington-Fayette Kentucky, Ann Arbor Michigan, Michigan, Albuquerque New Mexico, Rochester New York, Vancouver Washington, Texas, Mesa Arizona, St. Petersburg Florida, Idaho, Las Cruces New Mexico, New York, Kenosha Wisconsin, Racine Wisconsin, Dayton Ohio, Austin Texas, San Antonio Texas, West Valley City Utah, Layton Utah, Tampa Florida, Atlanta Georgia, Augusta Georgia, Caldwell Idaho, Lincoln Nebraska, Miami Florida, Buffalo New York, Wisconsin, Green Bay Wisconsin, Akron Ohio, Fort Worth Texas, Tacoma Washington, Georgia, Covington Kentucky, Washington, Madison Wisconsin, Columbus Ohio, Salt Lake City Utah, Chandler Arizona, Savannah Georgia, Columbus Georgia, Sioux City Iowa, Iowa City Iowa, Cedar Rapids Iowa, Grand Rapids Michigan, Nebraska, Grand Island Nebraska, Bellevue Washington, Milwaukee Wisconsin, Dallas Texas, Utah, Orem Utah, Phoenix Arizona, Florida, Jacksonville Florida, Kearney Nebraska 03/17/2025