Care Review Clinician; RN) Live in FL, Remote

About This Role

The Care Review Clinician (RN) will support Medicaid members recently admitted to the hospital, ensuring a successful transition from inpatient care to discharge. This role involves both telephonic outreach and in-person meetings with members while they are still hospitalized.

• Pay: $26.41 - $51.49/hour
• Location:
  
  Mid Florida, FL
• Schedule:
  
  Full Time, Monday through Friday, 8:00 AM to 5:00 PM EST

• Assess services for members to ensure optimum outcomes and compliance with regulations.
• Analyze clinical service requests against evidence-based clinical guidelines.
• Identify appropriate benefits, eligibility, and expected length of stay for treatments.
• Conduct reviews to determine prior authorization/financial responsibility.
• Process requests within required timelines.
• Refer appropriate cases to medical directors and present them efficiently.
• Request additional information from members or providers as needed.
• Make appropriate referrals to other clinical programs.
• Collaborate with multidisciplinary teams to promote the Molina care model.
• Adhere to utilization management (UM) policies and procedures.

• Registered Nurse (RN) License must be active and unrestricted in state of practice.

• At least 2 years experience in hospital acute care, inpatient review, prior authorization, or managed care.

• RN License in state of practice.

• Competitive benefits and compensation package.

Molina Healthcare is a leading healthcare provider committed to delivering exceptional patient care. They focus on providing quality and cost-effective member care across the continuum.