RN Care Review Clinician: Utilization & Prior Auth

Molina Healthcare; California (MO); Hybrid; USD 41,837 - 81,567; Full time

Job summary

Molina Healthcare in California seeks a Clinical Reviewer to support member service assessments and ensure services align with clinical guidelines. Responsibilities include analyzing service requests, conducting prior authorizations, and collaborating with teams to optimize member care.

The ideal candidate holds an active RN license and brings at least 2 years of experience. Molina offers a competitive benefits package and a pay range of $30.37 - $59.21 per hour.

Qualifications

• At least 2 years experience in hospital acute care, inpatient review, or managed care.
• Active and unrestricted RN license in state of practice.
• Ability to prioritize multiple deadlines.

Responsibilities

• Assesses services for members to ensure compliance with regulations.
• Analyzes clinical service requests against evidence-based guidelines.
• Conducts reviews for prior authorization for Molina and members.
• Collaborates with multidisciplinary teams to promote the Molina care model.

Skills

Organizational skills

Problem-solving skills

Critical thinking skills

Communication skills

Microsoft Office proficiency

Education

Registered Nurse (RN)

Job description

Molina Healthcare in California seeks a Clinical Reviewer to support member service assessments and ensure services align with clinical guidelines. Responsibilities include analyzing service requests, conducting prior authorizations, and collaborating with teams to optimize member care.

The ideal candidate holds an active RN license and brings at least 2 years of experience. Molina offers a competitive benefits package and a pay range of $30.37 - $59.21 per hour.