Care Review Clinician, Prior Auth (RN)
Molina Healthcare Arizona; Nampa, Idaho; Omaha, Nebraska; Mesa, Arizona; Utah; Wisconsin; Austin, Texas; Owensboro, Kentucky; Yonkers, New York; Tucson, Arizona; Syracuse, New York; Cleveland, Ohio; Nebraska; Ann Arbor, Michigan; Spokane, Washington; New York, New York; Columbus, Ohio; Florida; Covington, Kentucky; Houston, Texas; Grand Rapids, Michigan; West Valley City, Utah; Layton, Utah; Kenosha, Wisconsin; Georgia; Louisville, Kentucky; Roswell, New Mexico; Akron, Ohio; Miami, Florida; Tampa, Florida; Texas; Tacoma, Washington; Cedar Rapids, Iowa; Kearney, Nebraska; Iowa City, Iowa; Davenport, Iowa; Milwaukee, Wisconsin; Boise, Idaho; Cincinnati, Ohio; Lincoln, Nebraska; Jacksonville, Florida; Caldwell, Idaho; Rio Rancho, New Mexico; Bellevue, Nebraska; Salt Lake City, Utah; Warren, Michigan; Orem, Utah; Savannah, Georgia; Green Bay, Wisconsin; Sioux City, Iowa; Washington; Scottsdale, Arizona; Rochester, New York; Phoenix, Arizona; Chandler, Arizona; Racine, Wisconsin; Idaho Falls, Idaho; Santa Fe, New Mexico; Atlanta, Georgia; Sterling Heights, Michigan; Meridian, Idaho; Detroit, Michigan; Idaho; Des Moines, Iowa; Fort Worth, Texas; Augusta, Georgia; Macon, Georgia; Dallas, Texas; Vancouver, Washington; Madison, Wisconsin; Kentucky; Albuquerque, New Mexico; San Antonio, Texas; Provo, Utah; Las Cruces, New Mexico; Orlando, Florida; Columbus, Georgia; Iowa; Grand Island, Nebraska; Michigan; Lexington-Fayette, Kentucky; Bowling Green, Kentucky; Dayton, Ohio; St. Petersburg, Florida; Bellevue, Washington; Buffalo, New York; New York; New Mexico; Ohio Job ID 2029363JOB DESCRIPTION
Job Summary
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
KNOWLEDGE/SKILLS/ABILITIES
- Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
- Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
- Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
- Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
- Processes requests within required timelines.
- Refers appropriate prior authorization requests to Medical Directors.
- Requests additional information from members or providers in consistent and efficient manner.
- Makes appropriate referrals to other clinical programs.
- Collaborates with multidisciplinary teams to promote Molina Care Model
- Adheres to UM policies and procedures.
- Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
- Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Registered Nurse (RN).
Required Experience
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Preferred Experience
Previous experience in hospital Acute care, ER or ICU
Previous experience with InterQual or MCG guidelines
Work schedule: Mon - Fri daytime hours, some weekends and holidays required for all shifts.
**PACIFIC DAYTIME BUSINESS HOURS
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $26.41 - $61.79 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 12/18/2024ABOUT OUR LOCATION
View Map- Sr Bus Enterprise Risk & Controls (SOX Audit) - REMOTE Arizona, Atlanta Georgia, Des Moines Iowa, Cedar Rapids Iowa, Bowling Green Kentucky, Rochester New York, Idaho, Nebraska, West Valley City Utah, Layton Utah, Jacksonville Florida, Miami Florida, Macon Georgia, Nampa Idaho, Owensboro Kentucky, Detroit Michigan, Las Cruces New Mexico, Santa Fe New Mexico, Buffalo New York, Syracuse New York, Kentucky, Orem Utah, Vancouver Washington, Milwaukee Wisconsin, Green Bay Wisconsin, Tampa Florida, Idaho Falls Idaho, Sioux City Iowa, Iowa City Iowa, Grand Island Nebraska, Rio Rancho New Mexico, Columbus Ohio, Akron Ohio, San Antonio Texas, Salt Lake City Utah, Madison Wisconsin, Kenosha Wisconsin, Augusta Georgia, Savannah Georgia, Covington Kentucky, Grand Rapids Michigan, Omaha Nebraska, Cincinnati Ohio, New Mexico, Texas, Utah, Provo Utah, Davenport Iowa, Yonkers New York, Georgia, Dayton Ohio, Spokane Washington, Bellevue Washington, Chandler Arizona, Scottsdale Arizona, Louisville Kentucky, Lexington-Fayette Kentucky, Warren Michigan, Bellevue Nebraska, Kearney Nebraska, New York New York, Iowa, Michigan, Wisconsin, Seattle Washington, St. Petersburg Florida, Columbus Georgia, Boise Idaho, Ann Arbor Michigan, Roswell New Mexico, Houston Texas, Dallas Texas, Fort Worth Texas, Ohio, Tacoma Washington, Racine Wisconsin, Phoenix Arizona, Tucson Arizona, Orlando Florida, Meridian Idaho, Caldwell Idaho, Sterling Heights Michigan, Lincoln Nebraska, Albuquerque New Mexico, Cleveland Ohio, Florida, Austin Texas, New York, Washington, Mesa Arizona 01/03/2025
- Intern, Graduate Level Arizona, Ohio, Vancouver Washington, Chandler Arizona, Tampa Florida, Augusta Georgia, Caldwell Idaho, Cedar Rapids Iowa, Bellevue Nebraska, Syracuse New York, Columbus Ohio, Fort Worth Texas, Washington, Spokane Washington, Wisconsin, Meridian Idaho, Davenport Iowa, Omaha Nebraska, Rochester New York, Cleveland Ohio, Georgia, West Valley City Utah, Savannah Georgia, Bowling Green Kentucky, Owensboro Kentucky, Grand Rapids Michigan, Ann Arbor Michigan, Albuquerque New Mexico, Akron Ohio, Salt Lake City Utah, Texas, Utah, Milwaukee Wisconsin, Scottsdale Arizona, Atlanta Georgia, Louisville Kentucky, Lexington-Fayette Kentucky, Yonkers New York, Cincinnati Ohio, Houston Texas, Florida, Kentucky, Michigan, Tacoma Washington, Kenosha Wisconsin, Phoenix Arizona, Tucson Arizona, Mesa Arizona, Orlando Florida, Macon Georgia, Idaho Falls Idaho, Layton Utah, Nebraska, Jacksonville Florida, Nampa Idaho, Covington Kentucky, Kearney Nebraska, Santa Fe New Mexico, Roswell New Mexico, San Antonio Texas, Dallas Texas, New Mexico, New York, Green Bay Wisconsin, Racine Wisconsin, Miami Florida, Boise Idaho, Des Moines Iowa, Iowa City Iowa, Detroit Michigan, Grand Island Nebraska, Austin Texas, Iowa, Orem Utah, Bellevue Washington, Madison Wisconsin, St. Petersburg Florida, Columbus Georgia, Sioux City Iowa, Warren Michigan, Sterling Heights Michigan, Lincoln Nebraska, Las Cruces New Mexico, Rio Rancho New Mexico, New York New York, Buffalo New York, Dayton Ohio, Idaho, Provo Utah 01/23/2025
- Overreader, HEDIS/Quality Improvement (Remote) Arizona, Idaho, Iowa, Georgia, Kentucky, Michigan, Nebraska, New Mexico, Ohio, Texas, Utah, Wisconsin, Washington, New York, Florida 01/16/2025
- National Benefit Advisor - Medicare Telesales - Life/Health License Required (Remote) Preferred Bilingual: Spanish, Vietnamese, Cantonese, Mandarin, Tagalog and French Arizona, San Antonio Texas, Vancouver Washington, Seattle Washington, Idaho, Iowa, Nebraska, New Mexico, Texas, Nampa Idaho, Des Moines Iowa, Owensboro Kentucky, Ann Arbor Michigan, Albuquerque New Mexico, Las Cruces New Mexico, Cleveland Ohio, Florida, Miami Florida, Orlando Florida, St. Petersburg Florida, Atlanta Georgia, Augusta Georgia, Macon Georgia, Davenport Iowa, Lexington-Fayette Kentucky, Columbus Ohio, Fort Worth Texas, Green Bay Wisconsin, Chandler Arizona, Covington Kentucky, Detroit Michigan, Grand Rapids Michigan, Rochester New York, Dallas Texas, Layton Utah, Spokane Washington, Tacoma Washington, Madison Wisconsin, Idaho Falls Idaho, Iowa City Iowa, Kearney Nebraska, Roswell New Mexico, Bellevue Washington, Georgia, Savannah Georgia, Sterling Heights Michigan, Bellevue Nebraska, Grand Island Nebraska, Yonkers New York, Salt Lake City Utah, West Valley City Utah, Austin Texas, Orem Utah, Kenosha Wisconsin, Phoenix Arizona, Tucson Arizona, Kentucky, Meridian Idaho, Caldwell Idaho, Louisville Kentucky, Bowling Green Kentucky, Omaha Nebraska, Warren Michigan, Houston Texas, Cincinnati Ohio, Provo Utah, Racine Wisconsin, Scottsdale Arizona, Ohio, Jacksonville Florida, Boise Idaho, Columbus Georgia, Sioux City Iowa, Lincoln Nebraska, Buffalo New York, Syracuse New York, Dayton Ohio, Milwaukee Wisconsin, Mesa Arizona, Michigan, New York, Wisconsin, Utah, Washington, Tampa Florida, Cedar Rapids Iowa, Rio Rancho New Mexico, Santa Fe New Mexico, New York New York, Akron Ohio 01/17/2025