Remote RN - Prior Authorization Reviewer (Illinois Licensed)

Molina Healthcare; Northern (KY); Hybrid; USD 33,000 - 70,000; Full time

Job summary

Molina Healthcare is seeking an experienced RN for a fully remote Prior Authorization reviewer role. The position supports clinical member services and ensures services are medically necessary according to guidelines and policies.

Preference given to those with prior authorization in Molina-like managed care, with Illinois licensure in good standing. The role requires 2+ years in acute care or related areas, strong organizational and communication skills, and proficiency with Microsoft Office.

Qualifications

• Must be a licensed RN with active, unrestricted license in practice state.
• Minimum 2 years of experience in hospital acute care, inpatient review, or managed care.
• Ability to prioritize and manage multiple deadlines.
• Strong written and verbal communication skills.
• Proficient in Microsoft Office and related software.

Responsibilities

• Assess services for members to ensure optimal outcomes, cost-effectiveness, and compliance with regulations.
• Analyze clinical service requests against evidence-based guidelines.
• Determine benefits, eligibility, and length of stay for treatments.
• Conduct prior authorization/financial reviews for Molina and members.
• Refer cases to medical directors and present them clearly.
• Collaborate with multidisciplinary teams to promote the Molina care model.
• Adhere to utilization management policies and procedures.

Skills

Prior Authorization reviews

RN (Registered Nurse)

Time management

Communication

Microsoft Office

Education

Bachelor’s degree in Nursing

Tools

Microsoft Office Suite

Job description

Molina Healthcare is seeking an experienced RN for a fully remote Prior Authorization reviewer role. The position supports clinical member services and ensures services are medically necessary according to guidelines and policies.

Preference given to those with prior authorization in Molina-like managed care, with Illinois licensure in good standing. The role requires 2+ years in acute care or related areas, strong organizational and communication skills, and proficiency with Microsoft Office.