Utilization Management RN Clinician - Care Outcomes

Jobtome; Los Lunas (NM); On-site; USD 36,000 - 71,000; Full time

Job summary

Molina Healthcare in New Mexico seeks a Registered Nurse to support utilization management and review processes. The role ensures medical necessity and alignment with clinical guidelines, insurance policies, and regulations to achieve quality, cost-effective member care.

The ideal candidate has experience in hospital acute care, prior authorization, and multidisciplinary collaboration to promote the Molina care model and efficient care delivery.

Qualifications

• At least 2 years experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of education and experience.

Responsibilities

• Assess services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.

Skills

Organizational skills

Problem-solving

Critical thinking

Written communication

Verbal communication

Microsoft Office proficiency

Education

RN license

Tools

Microsoft Office

Job description

Molina Healthcare in New Mexico seeks a Registered Nurse to support utilization management and review processes. The role ensures medical necessity and alignment with clinical guidelines, insurance policies, and regulations to achieve quality, cost-effective member care.

The ideal candidate has experience in hospital acute care, prior authorization, and multidisciplinary collaboration to promote the Molina care model and efficient care delivery.