RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare · Bakersfield, California, United States
FULL TIMEpermanent
Job Description
Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Be one of the first applicants, read the complete overview of the role below, then send your application for consideration.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
• Collaborates with multidisciplinary teams to promote the Molina care model.
• Adheres to utilization management (UM) policies and procedures.
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). Microsoft Office suite/applicable software program(s) proficiency.
Certified Professional in Healthcare Management (CPHM).
Utilization review, prior authorization, inpatient review desirable. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. xzbcwsv
Remote working/work at home options are available for this role.
Be one of the first applicants, read the complete overview of the role below, then send your application for consideration.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
• Collaborates with multidisciplinary teams to promote the Molina care model.
• Adheres to utilization management (UM) policies and procedures.
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). Microsoft Office suite/applicable software program(s) proficiency.
Certified Professional in Healthcare Management (CPHM).
Utilization review, prior authorization, inpatient review desirable. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. xzbcwsv
Remote working/work at home options are available for this role.