Join Molina Healthcare as a Care Review Clinician, where you'll assess and coordinate integrated care for high-need members. Utilize your nursing expertise to ensure quality, cost-effective care while collaborating with multidisciplinary teams.
Key Responsibilities
Assess inpatient services to ensure optimum outcomes and compliance with regulations
Analyze clinical service requests against evidence-based clinical guidelines
Conduct inpatient reviews to determine financial responsibility for Molina Healthcare
Process requests within required timelines
Collaborate with multidisciplinary teams to promote Molina Care Model
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