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- Medical Director (Marketplace) Arizona, Phoenix Arizona, Jacksonville Florida, Idaho Falls Idaho, Yonkers New York, Nebraska, New York, West Valley City Utah, Bellevue Washington, Kenosha Wisconsin, Miami Florida, Davenport Iowa, Omaha Nebraska, Lincoln Nebraska, Rochester New York, Syracuse New York, Kentucky, Wisconsin, Tucson Arizona, St. Petersburg Florida, Bowling Green Kentucky, Detroit Michigan, Sterling Heights Michigan, New Mexico, Utah, Austin Texas, Salt Lake City Utah, Layton Utah, Green Bay Wisconsin, Chandler Arizona, Atlanta Georgia, Nampa Idaho, Iowa City Iowa, Owensboro Kentucky, Bellevue Nebraska, Kearney Nebraska, Iowa, Dayton Ohio, San Antonio Texas, Tampa Florida, Augusta Georgia, Columbus Georgia, Meridian Idaho, Caldwell Idaho, Des Moines Iowa, Warren Michigan, Albuquerque New Mexico, Rio Rancho New Mexico, Roswell New Mexico, Buffalo New York, Cincinnati Ohio, Houston Texas, Washington, Madison Wisconsin, Racine Wisconsin, Mesa Arizona, Orlando Florida, Boise Idaho, Cedar Rapids Iowa, Lexington-Fayette Kentucky, Covington Kentucky, Ann Arbor Michigan, Grand Island Nebraska, Idaho, Michigan, Columbus Ohio, Cleveland Ohio, Akron Ohio, Fort Worth Texas, Scottsdale Arizona, Sioux City Iowa, Louisville Kentucky, Las Cruces New Mexico, New York New York, Texas, Orem Utah, Spokane Washington, Macon Georgia, Savannah Georgia, Grand Rapids Michigan, Florida, Georgia, Santa Fe New Mexico, Ohio, Dallas Texas, Provo Utah, Seattle Washington, Tacoma Washington, Vancouver Washington, Milwaukee Wisconsin 02/04/2025
- Lead Data Analytics - SQL/ Databricks Arizona, Davenport Iowa, Iowa, Dallas Texas, Ohio, Spokane Washington, Tacoma Washington, Phoenix Arizona, Augusta Georgia, Nampa Idaho, Nebraska, San Antonio Texas, Salt Lake City Utah, Las Cruces New Mexico, Seattle Washington, Scottsdale Arizona, Atlanta Georgia, Owensboro Kentucky, Warren Michigan, Sterling Heights Michigan, Lincoln Nebraska, Layton Utah, Bellevue Washington, Miami Florida, Idaho Falls Idaho, Lexington-Fayette Kentucky, Columbus Ohio, Georgia, Bowling Green Kentucky, Akron Ohio, Texas, Bellevue Nebraska, Roswell New Mexico, Vancouver Washington, Mesa Arizona, St. Petersburg Florida, Savannah Georgia, Cedar Rapids Iowa, Louisville Kentucky, Idaho, Detroit Michigan, Dayton Ohio, Washington, Utah, New York, Grand Island Nebraska, Albuquerque New Mexico, Provo Utah, Rio Rancho New Mexico, Milwaukee Wisconsin, Jacksonville Florida, Columbus Georgia, Sioux City Iowa, Iowa City Iowa, Syracuse New York 03/05/2025
- Medical Director (Nebraska) Omaha Nebraska, Grand Island Nebraska, Kearney Nebraska, Lincoln Nebraska, Bellevue Nebraska 03/11/2025
- Pharmacy Technician, Clinical/MTM (Bilingual in Mandarin Required) - REMOTE PST Hours Arizona, Texas, Austin Texas, Wisconsin, Mesa Arizona, Bowling Green Kentucky, Columbus Georgia, Detroit Michigan, Nebraska, Ohio, Milwaukee Wisconsin, Jacksonville Florida, Sterling Heights Michigan, Augusta Georgia, Atlanta Georgia, Savannah Georgia, Utah, Las Cruces New Mexico, Tacoma Washington, Bellevue Washington, Racine Wisconsin, Meridian Idaho, Chandler Arizona, Idaho Falls Idaho, Covington Kentucky, Iowa City Iowa, San Antonio Texas, Rochester New York, Vancouver Washington, New York New York, Columbus Ohio, Green Bay Wisconsin, Sioux City Iowa, Tampa Florida, Louisville Kentucky, Michigan, Kearney Nebraska, Orem Utah, Layton Utah, Syracuse New York, Cincinnati Ohio, Madison Wisconsin, Des Moines Iowa, Davenport Iowa, Scottsdale Arizona, Nampa Idaho, Caldwell Idaho, Kentucky, Florida, Warren Michigan, Bellevue Nebraska, Cedar Rapids Iowa, West Valley City Utah, Provo Utah, Buffalo New York, New York, Spokane Washington, Owensboro Kentucky, Tucson Arizona, Georgia, Grand Island Nebraska, Roswell New Mexico, Rio Rancho New Mexico, Dallas Texas, Houston Texas, Yonkers New York, Salt Lake City Utah, Kenosha Wisconsin, Iowa, Boise Idaho, Miami Florida, Ann Arbor Michigan, Omaha Nebraska, Lincoln Nebraska, Santa Fe New Mexico, Fort Worth Texas, Washington, Seattle Washington, Cleveland Ohio, Akron Ohio, Dayton Ohio, Idaho, Phoenix Arizona, Lexington-Fayette Kentucky, Orlando Florida, St. Petersburg Florida, Macon Georgia, Grand Rapids Michigan, New Mexico, Albuquerque New Mexico 02/21/2025