Don't miss your next opportunity.

Upload Your Resume and Get Found by Leading Employers

Create a Free Account

Care Review Clinician (RN)

Molina Healthcare • Full-time • Akron, OH, US • $26 - $51 / hour • 20h ago

JOB DESCRIPTION

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all 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 within 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 Nurse (RN). License must be active and unrestricted in state of practice.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications
*Behavioral Health nursing experience- inpatient psychiatric, IMD, Residential SUD, IOP, PHP

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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.

By applying, you consent to your information being transmitted by GenZJobs to the Employer, as data controller, through the Employer’s data processor SonicJobs.
See Molina Healthcare Privacy Policy at https://www.molinahealthcare.com/members/common/en-US/Pages/terms_privacy.aspx? and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions

Related Jobs

RN - Med Surg in Akron, Ohio - $2,086/week

Vetted Health • Contractor • Akron, OH, US • $102k - $122.40k / year • 18h ago

Vetted is seeking a RN - Med Surg for a travel job in Akron, Ohio. The job was posted about 1 month ago. The assignment starts on ASAP and is 20 weeks long with 12 hour shifts 3 days a week.You must live 60 miles away fr...

18h ago

Apply

RN - Psychiatric in Akron, Ohio - $2,146/week

Vetted Health • Contractor • Akron, OH, US • $102k - $122.40k / year • 18h ago

Healthcare & Pharmaceutical Apply Onsite Retirement Plan 401k Match

Vetted is seeking a RN - Psychiatric for a travel job in Akron, Ohio. The job was posted 13 days ago. The assignment starts on ASAP and is 12 weeks long with 12 hour shifts 3 days a week.You must live 60 miles away from...

18h ago

Apply

RN - Med Surg in Akron, Ohio - $1,958/week

Vetted Health • Contractor • Akron, OH, US • $102k - $122.40k / year • 19h ago

Healthcare & Pharmaceutical Apply Onsite Retirement Plan 401k Match

Vetted is seeking a RN - Med Surg for a travel job in Akron, Ohio. The job was posted about 1 month ago. The assignment starts on ASAP and is 13 weeks long with 13 hour shifts 3 days a week.You must live 60 miles away fr...

19h ago

Apply

Registered Nurse - Sign On Bonus $5000

Caretenders • Full-time • Uniontown, OH, US • $60k - $72k / year • 20h ago

Healthcare & Pharmaceutical Nurse Apply Onsite Sign-On Bonus

We are hiring for a Full Time Registered Nurse. At Caretenders, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, th...

20h ago

Apply

Registered Nurse Case Manager Hospice - PRN

Caretenders Hospice • Full-time • Barberton, OH, US • $34 - $41 / hour • 20h ago

Social Services & Non-Profits Nurse Apply Onsite

We are hiring for a Registered Nurse Case Manager in Hospice. This is a PRN position doing Home Visits for Hospice in the South Cleveland/Akron area. Flexible schedule options! Home Care or Hospice experience preferred. ...

20h ago

Apply