Remote Care Review Clinician, Inpatient Review (RN) - TX ONLY
About the position The Utilization Review RN position at Molina Healthcare involves joining the inpatient review team to conduct initial and concurrent reviews, with opportunities for cross-training in prior authorization reviews. The role focuses on assessing and coordinating care for members with high needs, ensuring compliance with regulations, and promoting cost-effective healthcare delivery. Responsibilities • Conduct initial and concurrent reviews of inpatient services to ensure optimum outcomes and compliance with regulations. • Analyze clinical service requests against evidence-based clinical guidelines. • Identify appropriate benefits, eligibility, and expected length of stay for requested treatments or procedures. • Process requests within required timelines and refer cases to Medical Directors as necessary. • Collaborate with multidisciplinary teams to promote the Molina Care Model. • Request additional information from members or providers efficiently. • Perform prior authorization reviews and related duties as needed. Requirements • Graduate from an Accredited School of Nursing. • 3+ years of hospital acute care/medical experience. • Active, unrestricted State Registered Nursing (RN) license in good standing. • Valid driver's license with a good driving record. Nice-to-haves • Bachelor's Degree in Nursing • Recent hospital experience in ICU, Medical, or ER unit. • Active, unrestricted Utilization Management Certification (CPHM). Benefits • Competitive benefits and compensation package. Apply tot his job