Remote Care Review Clinician, Inpatient Review (RN) - TX ONLY
About the position
The Utilization Review RN position at Molina Healthcare involves joining the inpatient review team to conduct initial and concurrent reviews, with opportunities for cross-training in prior authorization reviews. The role focuses on assessing and coordinating care for members with high needs, ensuring compliance with regulations, and promoting cost-effective healthcare delivery.
Responsibilities
ā¢ Conduct initial and concurrent reviews of inpatient services to ensure optimum outcomes and compliance with regulations.
ā¢ Analyze clinical service requests against evidence-based clinical guidelines.
ā¢ Identify appropriate benefits, eligibility, and expected length of stay for requested treatments or procedures.
ā¢ Process requests within required timelines and refer cases to Medical Directors as necessary.
ā¢ Collaborate with multidisciplinary teams to promote the Molina Care Model.
ā¢ Request additional information from members or providers efficiently.
ā¢ Perform prior authorization reviews and related duties as needed.
Requirements
ā¢ Graduate from an Accredited School of Nursing.
ā¢ 3+ years of hospital acute care/medical experience.
ā¢ Active, unrestricted State Registered Nursing (RN) license in good standing.
ā¢ Valid driver's license with a good driving record.
Nice-to-haves
ā¢ Bachelor's Degree in Nursing
ā¢ Recent hospital experience in ICU, Medical, or ER unit.
ā¢ Active, unrestricted Utilization Management Certification (CPHM).
Benefits
ā¢ Competitive benefits and compensation package.
Apply Now
Apply Now
The Utilization Review RN position at Molina Healthcare involves joining the inpatient review team to conduct initial and concurrent reviews, with opportunities for cross-training in prior authorization reviews. The role focuses on assessing and coordinating care for members with high needs, ensuring compliance with regulations, and promoting cost-effective healthcare delivery.
Responsibilities
ā¢ Conduct initial and concurrent reviews of inpatient services to ensure optimum outcomes and compliance with regulations.
ā¢ Analyze clinical service requests against evidence-based clinical guidelines.
ā¢ Identify appropriate benefits, eligibility, and expected length of stay for requested treatments or procedures.
ā¢ Process requests within required timelines and refer cases to Medical Directors as necessary.
ā¢ Collaborate with multidisciplinary teams to promote the Molina Care Model.
ā¢ Request additional information from members or providers efficiently.
ā¢ Perform prior authorization reviews and related duties as needed.
Requirements
ā¢ Graduate from an Accredited School of Nursing.
ā¢ 3+ years of hospital acute care/medical experience.
ā¢ Active, unrestricted State Registered Nursing (RN) license in good standing.
ā¢ Valid driver's license with a good driving record.
Nice-to-haves
ā¢ Bachelor's Degree in Nursing
ā¢ Recent hospital experience in ICU, Medical, or ER unit.
ā¢ Active, unrestricted Utilization Management Certification (CPHM).
Benefits
ā¢ Competitive benefits and compensation package.
Apply Now
Apply Now