Talent.com
Care Review Clinician, PA (RN)

Care Review Clinician, PA (RN)

Molina HealthcareWest Valley City, UT, United States
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE / SKILLS / ABILITIES

  • Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
  • Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
  • Identifies appropriate benefits and eligibility for requested treatments and / or procedures.
  • Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
  • Processes requests within required timelines.
  • Refers appropriate prior authorization requests to Medical Directors.
  • Requests additional information from members or providers in consistent and efficient manner.
  • Makes appropriate referrals to other clinical programs.
  • Collaborates with multidisciplinary teams to promote Molina Care Model
  • Adheres to UM policies and procedures.
  • Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
  • Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.

JOB QUALIFICATIONS

Required Education

Completion of an accredited Registered Nurse (RN).

Required Experience

1-3 years of hospital or medical clinic experience.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Preferred Experience

Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

MULTI STATE / COMPACT LICENSURE

Individual state licensures required for : CA, NV, IL, and MI

WORK SCHEDULE : Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.

To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Pay Range : $26.41 - $51.49 / HOURLY

  • Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
  • serp_jobs.job_alerts.create_a_job

    Care Review Clinician Pa Rn • West Valley City, UT, United States

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    Care Review Clinician, Inpatient Review (RN)

    Care Review Clinician, Inpatient Review (RN)

    Molina HealthcareSalt Lake City, UT, United States
    serp_jobs.job_card.full_time
    JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes.Responsible for verifying that services are medically necessary and align with established clini...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Oncology - $31 to $45 per hour in Moab, UT

    Travel Nurse RN - Oncology - $31 to $45 per hour in Moab, UT

    TravelNurseSourceProvo, Utah, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Patterns LLC to find a qualified Oncology RN in Moab, Utah, 84532!.Provides direct nursing care in accordance within established scope and standards of practice, a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    PACU Registered Nurse PRN

    PACU Registered Nurse PRN

    Mountain West Surgery CenterBountiful, UT, US
    serp_jobs.job_card.full_time
    Do you have the PRN career opportunities as a PACU Registered Nurse PRN you want with your current employer? We have an exciting opportunity for you to join Mountain West Surgery Center which is pa...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Medical-Surgical - $1,822 to $2,037 per week in Saratoga Springs, UT

    Travel Nurse RN - Medical-Surgical - $1,822 to $2,037 per week in Saratoga Springs, UT

    TravelNurseSourceSaratoga Springs, UT, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Prime Time Healthcare to find a qualified Med / Surg RN in Saratoga Springs, Utah, 84043!. Now Hiring : RN Med Surg - Saratoga Springs, Utah.Contact us for Pay Informa...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Per Diem / PRN Nurse RN - Behavioral Health - $51-56 per hour

    Per Diem / PRN Nurse RN - Behavioral Health - $51-56 per hour

    HealthTrust Workforce Solutions LocalSalt Lake City, UT, United States
    serp_jobs.job_card.full_time
    HealthTrust Workforce Solutions Local is seeking a per diem / prn nurse RN Behavioral Health for a per diem / prn nursing job in Salt Lake City, Utah. Job Description & Requirements.Minimum of most ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Operating Room - $2,323 per week in Orem, UT

    Travel Nurse RN - Operating Room - $2,323 per week in Orem, UT

    TravelNurseSourceProvo, Utah, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with FlexCare to find a qualified OR RN in Orem, Utah, 84057!.FlexCare is a nationwide leader in the staffing of travel nurses and clinicians.With access to thousands o...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Care Review Processor (Remote) PST Hours

    Care Review Processor (Remote) PST Hours

    Molina HealthcareOrem, UT, United States
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting provision of integrated delivery of ca...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,825 to $2,025 per week in Murray, UT

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,825 to $2,025 per week in Murray, UT

    TravelNurseSourceWest Valley City, Utah, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Titan Medical Group to find a qualified ICU / Critical Care RN in Murray, Utah, 84107!. Titan Medical is looking for travelers to fill a Travel ICU position for a 12 ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Clinical Research Coordinator 1

    Clinical Research Coordinator 1

    AMR ClinicalLayton, UT, United States
    serp_jobs.job_card.full_time
    The Clinical Research Coordinator will perform and manage tasks that are critical to clinical research studies.The Clinical Research Coordinator must ensure compliance with federal regulations, stu...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    CDL-A Truck Driver - Home Weekly - Average $90,000 / Year + Benefits

    CDL-A Truck Driver - Home Weekly - Average $90,000 / Year + Benefits

    J.B. HuntMorgan, UT, United States
    serp_jobs.job_card.full_time
    Hunt is Now Hiring Regional CDL-A Truck Drivers in Ogden, UT.Average $90,000 per Year - Get Home Weekly!.Must have a valid CDL-A license and 3 months of experience. Drivers in this position average ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Experienced CDL-A Truck Driver - Earn $67,391 / Year + Home Time Options

    Experienced CDL-A Truck Driver - Earn $67,391 / Year + Home Time Options

    Hub GroupGrantsville, UT, US
    serp_jobs.job_card.full_time
    Hub Group is Now Hiring CDL-A Drivers in North Salt Lake City, UT!.Earn $67,391 per Year - Multiple Home Time Options - Excellent Benefits. Local and regional routes available.High-quality medical, ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Telemedicine Physician

    Telemedicine Physician

    QuickMDMorgan, UT, US
    serp_jobs.job_card.full_time
    QuickMD is a leading telemedicine provider, delivering high-quality virtual care across 44 states.Since our founding in 2019, we have helped more than 100,000 patients access essential medical trea...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Care Review Clinician, PA (RN)

    Care Review Clinician, PA (RN)

    Molina HealthcareOrem, UT, United States
    serp_jobs.job_card.full_time
    Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, inc...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Care Review Clinician (RN) (Must reside in MI)

    Care Review Clinician (RN) (Must reside in MI)

    Molina HealthcareLayton, UT, United States
    serp_jobs.job_card.full_time
    Provides support for clinical member services review assessment processes.Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance p...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Medical Claim Review Nurse (RN)

    Medical Claim Review Nurse (RN)

    Molina HealthcareSalt Lake City, UT, United States
    serp_jobs.job_card.full_time
    JOB DESCRIPTION Looking for a RN that has a current active unrestricted license This a remote role and can sit anywhere within the United States. Work Schedule Monday to Friday - operation hours 6...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Cardiac Catheterization Lab - $2,649 per week in Salt Lake City, UT

    Travel Nurse RN - Cardiac Catheterization Lab - $2,649 per week in Salt Lake City, UT

    TravelNurseSourceProvo, Utah, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with FlexCare to find a qualified Cath Lab RN in Salt Lake City, Utah, 84101!.FlexCare is a nationwide leader in the staffing of travel nurses and clinicians.With acces...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Oncology in Moab, UT

    Travel Nurse RN - Oncology in Moab, UT

    TravelNurseSourceProvo, Utah, US
    serp_jobs.job_card.full_time +1
    TravelNurseSource is working with Coast Medical Service to find a qualified Oncology RN in Moab, Utah, 84532!.Coast Medical Service is a nationwide travel nursing & allied healthcare staffing a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Care Review Clinician (RN)

    Care Review Clinician (RN)

    Molina HealthcareClearfield, UT, United States
    serp_jobs.job_card.full_time
    Provides support for clinical member services review assessment processes.Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance p...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    RN Carceral Care Manager Remote

    RN Carceral Care Manager Remote

    Molina HealthcareOrem, UT, United States
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, inc...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,822 to $2,037 per week in Vernal, UT

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,822 to $2,037 per week in Vernal, UT

    TravelNurseSourceProvo, Utah, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Prime Time Healthcare to find a qualified ICU / Critical Care RN in Vernal, Utah, 84078!. Now Hiring : RN ICU - Vernal, UT.Contact us for Pay Information.Actual amount...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days