RN Utilization Review Clinician - Prior Authorization

Jobtome; Bakersfield (CA); Remote; USD 42,000 - 82,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a registered nurse to support clinical member services review processes. The role emphasizes verifying medical necessity and alignment with guidelines, policies, and regulations to ensure high-quality, cost-effective care across the continuum.

The position involves utilization review, prior authorization, and collaboration with multidisciplinary teams to promote the Molina care model. Excellent communication and organizational skills are essential.

Qualifications

• RN with active license in state of practice.
• At least 2 years in hospital acute care, inpatient review, prior authorization or managed care.
• Strong prioritization and time-management skills.
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Office suite.

Responsibilities

• Assess services to ensure optimum outcomes, cost-effectiveness and regulatory compliance.
• Analyze clinical service requests against evidence-based guidelines.
• Identify benefits, eligibility and expected length of stay for requested treatments.
• Conduct reviews for prior authorization/financial responsibility for Molina and members.
• Collaborate with multidisciplinary teams to promote the Molina care model.

Skills

RN license

Prior authorization

Utilization review

Microsoft Office

Tools

MCG

Job description

Molina Healthcare is seeking a registered nurse to support clinical member services review processes. The role emphasizes verifying medical necessity and alignment with guidelines, policies, and regulations to ensure high-quality, cost-effective care across the continuum.

The position involves utilization review, prior authorization, and collaboration with multidisciplinary teams to promote the Molina care model. Excellent communication and organizational skills are essential.