Utilization Review Nurse: Medical Necessity & Claims Expert
Listed on 2026-10-15
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Nursing
Healthcare Nursing, Nurse Practitioner, Clinical Nurse Specialist, RN Nurse
Molina Healthcare seeks a Nurse Reviewer to conduct medical necessity reviews and ensure accurate coding for reimbursement. You will perform prospective, retrospective, and concurrent reviews, including appeals, DRG validation, and LTSS considerations, applying ICD-10, CPT/HCPCS, and state/federal guidelines.
Collaborate with medical directors and the CMO, present cases for hearings, train clinical peers, and identify members for Molina programs per policy.
This opportunity is for the Utilization Review Nurse:
Medical Necessity & Claims Expert role at Molina Healthcare.
The following opening is for a Utilization Review Nurse:
Medical Necessity & Claims Expert with Molina Healthcare.
Our organisation is growing, and we are hiring a Utilization Review Nurse:
Medical Necessity & Claims Expert in Gilbert, AZ, United States.
This opening is for the Utilization Review Nurse:
Medical Necessity & Claims Expert role at Molina Healthcare.
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