Care Review Clinician, Inpatient Review (RN) Remote based in Arizona

Lensa; Mesa (AZ); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare organization seeks a Care Review Clinician (RN) for a remote position based in Arizona. The role involves assessing inpatient services, ensuring compliance, and collaborating with teams to facilitate integrated care. Candidates must hold an Arizona RN license and have relevant experience in acute care. This position offers a competitive salary and benefits.

Qualifications

• 3+ years hospital acute care/medical experience required.
• Active, unrestricted RN license in Arizona in good standing.

Responsibilities

• Assess inpatient services for optimal outcomes and compliance.
• Conduct inpatient reviews and prior authorization reviews.
• Collaborate with multidisciplinary teams to promote care model.

Skills

Assessment

Analysis

Collaboration

Education

Bachelor's Degree in Nursing

Graduate from an Accredited School of Nursing

Job description

Care Review Clinician, Inpatient Review (RN) Remote based in Arizona

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

Molina Healthcare Services (HCS) collaborates with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate integrated care across the continuum, including behavioral health and long-term care, for members with high needs. HCS staff aim to ensure patients reach desired outcomes with quality, medically appropriate, and cost-effective care based on illness severity and service site.

This position supports the Arizona State Plan. Candidates must hold an Arizona RN license. Preferred candidates will have experience with UM and prior authorization for inpatient and outpatient services. Behavioral health experience is highly desirable. Details will be discussed during the interview process.

Remote position, must reside in Arizona.

Work hours: Monday - Friday, 8:30 am - 5:00 pm Mountain Time, with some weekends and holidays.

Knowledge/Skills/Abilities

• Assess inpatient services to ensure optimal outcomes, cost efficiency, and compliance with regulations.
• Analyze clinical service requests against evidence-based guidelines.
• Determine appropriate benefits, eligibility, and expected length of stay.
• Conduct inpatient reviews to assess financial responsibility; perform prior authorization reviews as needed.
• Process requests within required timelines.
• Refer cases to Medical Directors efficiently and consistently.
• Request additional information from members or providers as needed.
• Make referrals to other clinical programs.
• Collaborate with multidisciplinary teams to promote Molina Care Model.
• Adhere to UM policies and procedures.
• Occasional travel to other Molina offices or hospitals may be required, varying by State Plan.

Job Qualifications

Required Education: Graduate from an Accredited School of Nursing.

Required Experience: 3+ years hospital acute care/medical experience.

Required License: Active, unrestricted RN license in Arizona in good standing; valid driver’s license with reliable transportation.

State Specific Requirements: Licensed in Arizona.

Preferred Education: Bachelor's Degree in Nursing.

Preferred Experience: Recent ICU, Medical, or ER hospital experience; familiarity with MCG and InterQual guidelines; behavioral health and utilization management experience.

Preferred License: Utilization Management Certification (CPHM).

If you are a current Molina employee, please apply through the intranet. Molina offers competitive benefits. We are an EOE M/F/D/V.

Pay Range: $26.41 - $51.49/hour