REMOTE CARE REVIEW CLINICIAN (RN)

✨ About The Role

- The RN Care Review Clinician will assess services for members to ensure optimum outcomes, cost-effectiveness, and compliance with regulations - Responsibilities include analyzing clinical service requests, identifying appropriate benefits, and conducting prior authorization reviews - The role involves collaborating with multidisciplinary teams, making appropriate referrals, and processing requests within required timelines - Occasional travel to other Molina offices or hospitals may be required, with reliable transportation needed for internal meetings - This position supports the Senior Whole Health business, focusing on Managed Long-Term Care (MLTC) and Medicaid Advantage (MAP) plans

⚡ Requirements

- Registered Nurse with 1-3 years of hospital or medical clinic experience, appeals background, quality reviews, and MLTC/LTC experience - Strong MS Excel skills and experience with data collection/reports - Ability to assess services for members, ensure compliance with regulations, and analyze clinical service requests against guidelines - Collaborative team player with the ability to promote the Molina Care Model and adhere to UM policies and procedures - Bilingual candidates who speak Spanish or Mandarin are encouraged to apply