Care Review Clinician; RN) Kentucky

About This Role

The Care Review Clinician (RN) at Molina Healthcare is responsible for assessing clinical member services to ensure that services are medically necessary and comply with established guidelines. This role is ideal for experienced RNs looking to contribute to quality and cost-effective member care.

• Pay: $23 - $51/hour
• Location:
  
  Remote, US
• Schedule:
  
  Full Time

• 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 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.

Education:

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

Experience:

• At least 2 years experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of education and experience.

Licenses &

Certifications:

• Current 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 services to their members across the continuum of care.