RN Care Review Clinician: Utilization & Outcomes Advocate

Jobtome; Fresno (CA); Remote; USD 42.000 - 82.000; Vollzeit

Benefits dieser Stelle

Competitive benefits

Zusammenfassung

Molina Healthcare is seeking a Registered Nurse for utilization review and prior authorization roles in California. The position involves assessing medical necessity, reviewing clinical service requests, and collaborating with multidisciplinary teams to promote cost-effective member care.

Requires strong organizational and communication skills, 2+ years of relevant experience, and active RN licensure. Competitive hourly compensation and comprehensive benefits are offered.

Qualifikationen

• Active RN license in state of practice.
• Minimum 2 years in hospital acute care, inpatient review, prior authorization, managed care, or equivalent.
• Strong written and verbal communication skills.

Aufgaben

• Assess services for members to ensure optimal outcomes and compliance with state/federal regulations.
• Analyze clinical service requests against evidence-based guidelines.
• Identify benefits, eligibility and expected length of stay for treatments.

Kenntnisse

Communication

Organizational skills

Problem-solving

Prioritization

Ausbildung

RN license (active)

Tools

Microsoft Office

Jobbeschreibung

Molina Healthcare is seeking a Registered Nurse for utilization review and prior authorization roles in California. The position involves assessing medical necessity, reviewing clinical service requests, and collaborating with multidisciplinary teams to promote cost-effective member care.

Requires strong organizational and communication skills, 2+ years of relevant experience, and active RN licensure. Competitive hourly compensation and comprehensive benefits are offered.