Join Molina Healthcare as a Care Review Clinician where you'll assess and coordinate care for high-need members, ensuring quality and cost-effective outcomes. Collaborate with multidisciplinary teams and utilize your clinical expertise to make a positive impact on patient care.
Key Responsibilities
Assess inpatient services for members to ensure optimum outcomes and compliance with regulations
Analyze clinical service requests against evidence-based clinical guidelines
Conduct inpatient reviews to determine financial responsibility
Process requests within required timelines
Collaborate with multidisciplinary teams to promote Molina Care Model
Make appropriate referrals to other clinical programs
Required Qualifications
Graduate from an Accredited School of Nursing
3+ years hospital acute care/medical experience
Active, unrestricted State Registered Nursing (RN) license in good standing
Valid driver's license with good driving record
Preferred Qualifications
Previous experience in Hospital Acute Care, ER or ICU
Experience in Prior Auth, Utilization Review / Utilization Management