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Job Description
Join Molina Healthcare as a Care Review Clinician (RN) to assess and coordinate care for high-need patients. Utilize your nursing expertise to ensure quality outcomes and compliance with regulations while working with a dedicated multidisciplinary team.
Key Responsibilities
Assess inpatient services for members
Analyze clinical service requests against evidence-based clinical guidelines
Identify appropriate benefits and expected length of stay for treatments
Conduct inpatient reviews to determine financial responsibility
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