Care Review Clinician, PA (RN) - Transplant Team - Compact License
Molina Healthcare
Sterling Heights, MI
1 month ago
$26.41 - $61.79
Job Description
Join Molina Healthcare as a Care Review Clinician, where you'll utilize your RN expertise to review transplant authorization requests, ensuring optimal patient outcomes and compliance with healthcare guidelines. This role demands excellent analytical skills and the ability to work efficiently within a dynamic team environment.
Key Responsibilities
Review prior authorization requests for transplants
Assess services to ensure optimum outcomes and compliance
Analyze clinical service requests against evidence-based guidelines
Conduct prior authorization reviews and determine financial responsibility
Collaborate with multidisciplinary teams
Meet specified turnaround times for request processing
Required Qualifications
Active, unrestricted State Registered Nursing (RN) license
Completion of an accredited Registered Nurse (RN) program
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
Familiarity with Microsoft Office Suite (Outlook, Excel, Teams, One Note)