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Job Description
Join Molina Healthcare as a Care Review Clinician (RN) to lead the assessment and coordination of care for high-need patients. Collaborate with multidisciplinary teams to ensure quality, cost-effective patient outcomes while adhering to regulatory guidelines.
Key Responsibilities
Assess inpatient services for optimum outcomes and compliance with regulations
Analyze clinical service requests against evidence-based guidelines
Identify benefits, eligibility, and expected length of stay for treatments
Conduct inpatient reviews to determine financial responsibility
Process requests within required timelines
Refer cases to Medical Directors as necessary
Request additional information efficiently from members or providers
Make referrals to other clinical programs
Collaborate with multidisciplinary teams
Adhere to UM policies and procedures
Occasional travel to other Molina offices or hospitals
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