Care Review Clinician, PA (RN)
Molina HealthcareLogandale, NV, USjob_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
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job_description.job_card.job_descriptionNevada residents preferred. Candidates who do not live in NV must work Pacific Business Hours permanently.\n\nJOB DESCRIPTION\n\nJob Summary\n\nMolina 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.\n\nKNOWLEDGE / SKILLS / ABILITIES\n Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.\n Analyzes clinical service requests from members or providers against evidence based clinical guidelines.\n Identifies appropriate benefits and eligibility for requested treatments and / or procedures.\n Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.\n Processes requests within required timelines.\n Refers appropriate prior authorization requests to Medical Directors.\n Requests additional information from members or providers in consistent and efficient manner.\n Makes appropriate referrals to other clinical programs.\n Collaborates with multidisciplinary teams to promote Molina Care Model\n Adheres to UM policies and procedures.\n Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.\n Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.\n\nJOB QUALIFICATIONS\n\nRequired Education\n\nCompletion of an accredited Registered Nurse (RN).\n\nRequired Experience\n\n1-3 years of hospital or medical clinic experience.\n\nRequired License, Certification, Association\n\nActive, unrestricted State Registered Nursing (RN) license in good standing.\n\nPreferred Experience\n\nPrevious experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.\n\nPreferred License, Certification, Association\n\nActive, unrestricted Utilization Management Certification (CPHM).\n\nNEVADA State Specific Requirements : \n\nMust be licensed currently for the state of Nevada. Nevada is not a compact state.\n\nWORK SCHEDULE : Mon - Fri / Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.\n\nTraining will be held Mon - Fri\n\nTo all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.\n\nMolina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.\n\nPay Range : $27.73 - $59.21 / HOURLY\n Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
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Clinician Rn • Logandale, NV, US
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Are you looking for more? Find it here.At Wells Fargo, we're more than a financial services leader - we're a global trailblazer committed to driving innovation, empowering communities, and helping ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better.
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Remote Jobs are now available in your area.This position is a work from home position.You will not need to come into the office.
Benefits : Health Insurance, 401K, Vacation& PTO.Apply now! Work f...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days USPS is accepting applications for City Carrier Assistants nationwide.This role ensures smooth postal operations by delivering mail efficiently.
No prior experience is required, as USPS offers compr...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours Candidates who do not live in NV must work Pacific Business Hours permanently.JOB DESCRIPTION\n\nJob Summary\n\nMolina Healthcare Services (HCS) works with members, providers and multidisciplinary ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day 
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 USPS is accepting applications for PSE Sales & Services / Distribution Associate nationwide.This role ensures the smooth distribution of mail while offering professional customer support.USPS provide...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours Nevada residency required\n\nJOB DESCRIPTION\n\nJob Summary\n\nMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coor...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours Are you looking for more? Find it here.At Wells Fargo, we're more than a financial services leader - we're a global trailblazer committed to driving innovation, empowering communities, and helping ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days Are you looking for more? Find it here.At Wells Fargo, we're more than a financial services leader - we're a global trailblazer committed to driving innovation, empowering communities, and helping ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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