Talent.com
Care Review Clinician (RN) (Must reside in MI)
Care Review Clinician (RN) (Must reside in MI)Molina Healthcare • SPOKANE, WA, United States
Care Review Clinician (RN) (Must reside in MI)

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

Molina Healthcare • SPOKANE, WA, 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

Provides support for clinical member services review assessment processes. 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.

Essential Job Duties

  • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state / federal regulations and guidelines.
  • Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
  • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and / or procedures.
  • Conducts reviews to determine prior authorization / financial responsibility for Molina and its members.
  • Processes requests within required timelines.
  • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
  • Requests additional information from members or providers as needed.
  • Makes appropriate referrals to other clinical programs.
  • Collaborates with multidisciplinary teams to promote the Molina care model.
  • Adheres to utilization management (UM) policies and procedures.

Required Qualifications

  • 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). License must be active and unrestricted in state of practice.
  • Ability to prioritize and manage multiple deadlines.
  • Excellent organizational, problem-solving and critical-thinking skills.
  • Strong written and verbal communication skills.
  • Microsoft Office suite / applicable software program(s) proficiency.
  • Preferred Qualifications

  • Certified Professional in Healthcare Management (CPHM).
  • Recent hospital experience in an intensive care unit (ICU) or emergency room.
  • To all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board.

    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 - $61.79 / 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 • SPOKANE, WA, United States

    Job_description.internal_linking.related_jobs
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,945 to $2,069 per week in Silverdale, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,945 to $2,069 per week in Silverdale, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Fusion Medical Staffing to find a qualified ICU / Critical Care RN in Silverdale, Washington, 98383!. Facility in Silverdale, Washington.Fusion Medical Staffing is se...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,088 to $2,221 per week in Seattle, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,088 to $2,221 per week in Seattle, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Fusion Medical Staffing to find a qualified ICU / Critical Care RN in Seattle, Washington, 98195!. Facility in Seattle, Washington.Fusion Medical Staffing is seeking ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,893 to $2,013 per week in Yakima, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,893 to $2,013 per week in Yakima, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Fusion Medical Staffing to find a qualified ICU / Critical Care RN in Yakima, Washington, 98902!. Facility in Yakima, Washington.Fusion Medical Staffing is seeking a ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,916 to $2,110 per week in Yakima, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,916 to $2,110 per week in Yakima, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time +2
    TravelNurseSource is working with Thrive Staffing to find a qualified ICU / Critical Care RN in Yakima, Washington, 98902!. Join Our Team at Thrive Staffing!.Are you a skilled ICU, RN? Thrive Staffing...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,192 per week in Kennewick, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,192 per week in Kennewick, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Openwork Health to find a qualified ICU / Critical Care RN in Kennewick, Washington, 99338!. Openwork Health Is Hiring! Let’s Chase Big Dreams—Together.We’re not your...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,286 per week in Kennewick, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,286 per week in Kennewick, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Care Career to find a qualified ICU / Critical Care RN in Kennewick, Washington, 99338!. ICU registered nurses (RNs) provide care to critical medical, surgical and tr...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Care Manager RN

    Care Manager RN

    Providence Health and Services • Spokane, WA, US
    serp_jobs.job_card.full_time
    Care Manager RN - Case Management, Providence Sacred Heart Medical Center & Children's Hospital, Spokane WA.The Inpatient Registered Nurse (RN) Care Manager provides professional, comprehen...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,964 to $2,164 per week in Silverdale, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,964 to $2,164 per week in Silverdale, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Ventura MedStaff to find a qualified ICU / Critical Care RN in Silverdale, Washington, 98383!. Are you ready to take your Travel career to the next level? See places...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,766 to $1,958 per week in Auburn, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,766 to $1,958 per week in Auburn, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in Auburn, Washington, 98001!. Ready to start your next travel adventure? LRS Healthcare offers a full benef...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Coronary Care - $1,985 to $2,200 per week in Seattle, WA

    Travel Nurse RN - Coronary Care - $1,985 to $2,200 per week in Seattle, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with LRS Healthcare to find a qualified Coronary Care RN in Seattle, Washington, 98122!.Ready to start your next travel adventure? LRS Healthcare offers a full benefits...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,053 per week in Silverdale, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,053 per week in Silverdale, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Atlas MedStaff to find a qualified ICU / Critical Care RN in Silverdale, Washington, 98383!. Atlas Medstaff is currently seeking candidates in the RN (ICU / CCU / Critica...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,053 per week in Kennewick, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,053 per week in Kennewick, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Atlas MedStaff to find a qualified ICU / Critical Care RN in Kennewick, Washington, 99338!. Atlas Medstaff is currently seeking candidates in the RN (ICU / CCU / Critical...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,939 to $2,150 per week in Mount Vernon, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,939 to $2,150 per week in Mount Vernon, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with LRS Healthcare to find a qualified ICU / Critical Care RN in Mount Vernon, Washington, 98273!. Ready to start your next travel adventure? LRS Healthcare offers a full...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    RN Resident - Cardiac Telemetry

    RN Resident - Cardiac Telemetry

    Providence Health and Services • Spokane, WA, US
    serp_jobs.job_card.full_time
    Up to $15,000 hiring bonus for eligible external hires that meet required qualifications and conditions for payment.Registered Nurse Resident (RN Resident) – Cardiac Telemetry at Providence S...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,952 per week in Kennewick, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,952 per week in Kennewick, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with GetMed Staffing to find a qualified ICU / Critical Care RN in Kennewick, Washington, 99336!. GetMed Staffing is searching for a strong ICU RN to assist our traveler-f...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,048 per week in Kennewick, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,048 per week in Kennewick, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Magnet Medical to find a qualified ICU / Critical Care RN in Kennewick, Washington, 99336!. Purpose of the Position : Responsible for the delivery of direct patient ca...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    RN, Progressive Care Unit

    RN, Progressive Care Unit

    Providence Health and Services • Spokane, WA, US
    serp_jobs.job_card.full_time
    Providence is offering up to $15,000 Hiring Bonus for eligible external candidates who meet all conditions for payment - this is in addition to the fantastic benefits and compensation package offer...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,952 to $2,146 per week in Silverdale, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,952 to $2,146 per week in Silverdale, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time +2
    TravelNurseSource is working with Thrive Staffing to find a qualified ICU / Critical Care RN in Silverdale, Washington, 98383!. Join Our Team at Thrive Staffing!.Are you a skilled ICU, RN? Thrive Staf...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,685 to $1,880 per week in Auburn, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,685 to $1,880 per week in Auburn, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time +2
    TravelNurseSource is working with Thrive Staffing to find a qualified ICU / Critical Care RN in Auburn, Washington, 98001!. Join Our Team at Thrive Staffing!.Are you a skilled ICU, RN? Thrive Staffing...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,031 per week in Mount Vernon, WA

    Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $2,031 per week in Mount Vernon, WA

    TravelNurseSource • Spokane, Washington, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with Atlas MedStaff to find a qualified ICU / Critical Care RN in Mount Vernon, Washington, 98274!. Atlas Medstaff is currently seeking candidates in the RN (ICU / CCU / Criti...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted