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

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

Job summary

An established industry player in healthcare is seeking a Care Review Clinician to join their dedicated team. This remote position requires an Arizona RN license and offers the opportunity to make a significant impact on patient care by assessing and coordinating integrated services. Ideal candidates will have a strong background in Utilization Management and experience in inpatient settings, particularly in behavioral health. Enjoy a collaborative work environment focused on quality and cost-effective care, along with a competitive hourly wage and benefits. If you are passionate about improving patient outcomes and thrive in a dynamic healthcare setting, this role is perfect for you.

Qualifications

• 3+ years of hospital acute care/medical experience required.
• Active RN license in good standing is necessary.

Responsibilities

• Ensure optimal outcomes and compliance with regulations.
• Conduct inpatient reviews to determine financial responsibility.

Skills

Assess inpatient services

Analyze clinical service requests

Prior authorization reviews

Collaborate with multidisciplinary teams

Education

Graduate from an Accredited School of Nursing

Bachelor's Degree in Nursing

Tools

MCG guidelines

InterQual guidelines

Job description

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

2 days ago Be among the first 25 applicants

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-need potential. HCS staff work to ensure patients progress toward desired outcomes with quality, medically appropriate, and cost-effective care based on illness severity and site of service.

This position supports the Arizona state Plan. Candidates must hold an Arizona RN license. The ideal candidate will have experience with UM and prior authorization for inpatient and outpatient settings. Behavioral health background is highly preferred. Details will be discussed during the interview process.

Remote position, must reside in Arizona.

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

Knowledge/Skills/Abilities

• Assess inpatient services to ensure optimal outcomes, cost-effectiveness, and compliance with regulations.
• Analyze clinical service requests against evidence-based guidelines.
• Identify benefits, eligibility, and expected length of stay for treatments/procedures.
• Conduct inpatient reviews to determine financial responsibility; perform prior authorization reviews as needed.
• Process requests within required timelines.
• Refer cases to Medical Directors and present them efficiently.
• Request additional information from members or providers.
• 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, depending on the State Plan.

Job Qualifications

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

Active, unrestricted State RN license in good standing. Valid driver’s license with a good driving record and reliable transportation. Must be licensed in the appropriate state.

Preferred Education

Bachelor's Degree in Nursing.

Preferred Experience

Recent hospital experience in ICU, Medical, or ER units. Experience with MCG and/or InterQual guidelines. Behavioral health and Physical Health Utilization Management reviews experience.

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

Current employees should apply through the intranet. Molina Healthcare offers competitive benefits. EOE M/F/D/V.

Pay Range: $26.41 - $51.49 / HOURLY

• Compensation varies based on location, experience, education, and skills.