Care Review Clinician, PA (RN) - Transplant Team - Compact License
Molina Healthcare
Madison, WI
1 month ago
$26.41 - $61.79
Job Description
Join Molina Healthcare as a Care Review Clinician (RN) on the Transplant Team, where you'll play a crucial role in reviewing prior authorization requests for transplant services. The ideal candidate will have a strong background in utilization review or case management, particularly in transplant settings, and will thrive in a fast-paced environment focused on quality care and cost-effectiveness.
Key Responsibilities
Assess services for members to ensure optimum outcomes and compliance with regulations
Analyze clinical service requests against evidence-based clinical guidelines
Conduct prior authorization reviews to determine financial responsibility
Process requests within required timelines
Collaborate with multidisciplinary teams to promote Molina Care Model
Refer requests to Medical Directors as necessary
Required Qualifications
Active, unrestricted State Registered Nursing (RN) license in good standing
Completion of an accredited Registered Nurse (RN)
1-3 years of hospital or medical clinic experience
Preferred Qualifications
Experience in utilization review or case management for transplants
Experience with Interqual/MCG guidelines
Solid experience with Microsoft Office Suite
Benefits & Perks
Competitive benefits and compensation packageOpportunity for career growthHealth insurance