Talent.com
Care Review Clinician, PA (RN)

Care Review Clinician, PA (RN)

Molina HealthcareLas Cruces, NM, 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 • Las Cruces, NM, United States

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

    Care Review Clinician (RN)

    Molina HealthcareLas Cruces, NM, 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
    Care Review Clinician, Inpatient Review (RN)

    Care Review Clinician, Inpatient Review (RN)

    Molina HealthcareLas Cruces, NM, US
    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
    Clinical Manager (RN) Emergency Room (ER) (Las Cruces)

    Clinical Manager (RN) Emergency Room (ER) (Las Cruces)

    Virtus Healthcare StaffingLas Cruces, NM, US
    serp_jobs.job_card.full_time +1
    EmergencyNursing #NurseLeadership #RNJobs #HospitalCareers #ClinicalExcellence.Clinical Manager (RN) - Emergency Room (ER). Virtus Healthcare Staffing seeks a compassionate and dynamic.Emergency Dep...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,562 to $1,721 per week in Roswell, NM

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,562 to $1,721 per week in Roswell, NM

    TravelNurseSourceLas Cruces, New Mexico, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with AMN Healthcare to find a qualified ICU / Critical Care RN in ROSWELL, New Mexico, 88201!. Job Description & Requirements.Registered Nurse – Intensive Care - ICU ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,504 to $1,736 per week in Roswell, NM

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,504 to $1,736 per week in Roswell, NM

    TravelNurseSourceLas Cruces, New Mexico, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with National Staffing Solutions to find a qualified ICU / Critical Care RN in Roswell, New Mexico, 88201!. Details of the RN - Intensive Care Unit (ICU) opening in Roswel...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Trauma RN Clinical Coordinator

    Trauma RN Clinical Coordinator

    Memorial Medical CenterLas Cruces, NM, US
    serp_jobs.job_card.full_time +1
    Memorial Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so...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 HealthcareLas Cruces, NM, US
    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_less
    • serp_jobs.job_card.promoted
    Care Review Clinician, Inpatient (RN) - TX or NM residency

    Care Review Clinician, Inpatient (RN) - TX or NM residency

    Molina HealthcareLas Cruces, NM, 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
    • serp_jobs.job_card.new
    RN Carceral Care Manager Remote

    RN Carceral Care Manager Remote

    Molina HealthcareLas Cruces, NM, 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 - $1,512 to $1,608 per week in Roswell, NM

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,512 to $1,608 per week in Roswell, NM

    TravelNurseSourceLas Cruces, New Mexico, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Fusion Medical Staffing to find a qualified ICU / Critical Care RN in Roswell, New Mexico, 88201!. Facility in Roswell, New Mexico.Fusion Medical Staffing is seeking ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    Clinical Manager - Emergency Room (RN)

    Clinical Manager - Emergency Room (RN)

    BlackStarLas Cruces, New Mexico, United States
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Clinical Manager, Emergency Room (RN).ER nursing team in Las Cruces, NM.This is an exciting opportunity to combine your clinical expertise with leadership skills to deliver exceptional patien...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,890 to $1,971 per week in Roswell, NM

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,890 to $1,971 per week in Roswell, NM

    TravelNurseSourceLas Cruces, New Mexico, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Greenstaff Medical to find a qualified ICU / Critical Care RN in Roswell, New Mexico, 88201!. Why Choose Greenstaff Medical US?.Your Trusted Partner in Healthcare Sta...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 HealthcareLas Cruces, NM, 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
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,708 to $1,910 per week in Roswell, NM

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,708 to $1,910 per week in Roswell, NM

    TravelNurseSourceLas Cruces, New Mexico, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Prime Time Healthcare to find a qualified ICU / Critical Care RN in Roswell, New Mexico, 88201!. Now Hiring : RN ICU - Roswell, NM.Contact us for Pay Information.Actua...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Apply Now : Clinical Nurse (RN) Inpatient Ortho / Full-time...

    Apply Now : Clinical Nurse (RN) Inpatient Ortho / Full-time...

    Christus HealthLas Cruces, US
    serp_jobs.job_card.full_time
    Description Please enter info here Requirements MINIMUM QUALIFICATIONS : EDUCATION : Graduate of an accredited program for Registered Nursing. CERTIFICATION / LICENSES : Current New Mexico RN license or ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    Registered Nurse, ICU

    Registered Nurse, ICU

    Memorial Medical CenterLas Cruces, NM, United States
    serp_jobs.job_card.full_time
    Job Type : Full time, Nights 3-12s.At Memorial Medical Center, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others.Here, you're not ju...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,640 to $1,833 per week in Roswell, NM

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,640 to $1,833 per week in Roswell, NM

    TravelNurseSourceLas Cruces, New Mexico, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Prime Time Healthcare to find a qualified ICU / Critical Care RN in Roswell, New Mexico, 88201!. Now Hiring : RN ICU - Roswell, NM.Contact us for Pay Information.Actua...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Clinical Manager (RN) – Emergency Room (ER)

    Clinical Manager (RN) – Emergency Room (ER)

    Virtus Healthcare StaffingLas Cruces, NM, United States
    serp_jobs.job_card.full_time
    EmergencyNursing #NurseLeadership #RNJobs #HospitalCareers #ClinicalExcellence.Clinical Manager (RN) - Emergency Room (ER). Virtus Healthcare Staffing seeks a compassionate and dynamic.Emergency Dep...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days