Care Review Clinician, PA (RN) - Transplant Team - Compact License
Molina Healthcare
Columbus, GA
1 month ago
$26.41 - $61.79
Job Description
Join Molina Healthcare as a Care Review Clinician, specializing in transplant cases. Utilize your nursing expertise to assess and coordinate care, ensuring high-quality outcomes for members. This role requires strong analytical skills and experience in utilization review or case management.
Key Responsibilities
Assess services for members to ensure optimum outcomes and compliance
Analyze clinical service requests against evidence-based clinical guidelines
Conduct prior authorization reviews and process requests within required timelines
Collaborate with multidisciplinary teams to promote Molina Care Model
Make referrals to other clinical programs and medical directors as needed
Travel to other Molina offices or hospitals as required
Required Qualifications
Active, unrestricted State Registered Nursing (RN) license in good standing
1-3 years of hospital or medical clinic experience
Completion of an accredited Registered Nurse (RN)
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 packageHealth insurance401kPTO