MH

Hybrid Remote Care Review Clinician, PA (RN) – Illinois

Remote position, IL

$49k - $107k (est.)

Overview

Are you an RN with experience in utilization management or prior authorization? We have an exciting opportunity for you to join our Utilization Department at Molina Healthcare Services. In this role, you will be responsible for conducting reviews for Prior Authorizations, assessing services for members, and ensuring optimum outcomes and cost-effectiveness. We require an active, unrestricted State Registered Nursing license and 1-3 years of hospital or medical clinic experience. If you're looking for a meaningful opportunity in a team-oriented environment, come be a part of our highly engaged workforce dedicated to providing quality healthcare to those in need. Apply today!

Job Description

JOB DESCRIPTION

Opportunity for RN to work in our Utilization Department conducting reviews for Prior Authorizations. Preferred candidates will have experience in UM or prior authorization as well as well-rounded hospital clinical experience. While this is open to applicants nation wide, an Illinois RN license is REQUIRED to be considered (compact state licenses will not work). Weekend and holiday rotations are part of the scheduling for this department in addition to a Monday – Friday schedule.  

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

  • Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
  • Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
  • Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
  • Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
  • Processes requests within required timelines.
  • Refers appropriate prior authorization requests to Medical Directors.
  • Requests additional information from members or providers in consistent and efficient manner.
  • Makes appropriate referrals to other clinical programs.
  • Collaborates with multidisciplinary teams to promote Molina Care Model
  • Adheres to UM policies and procedures.
  • Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
  • Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.

JOB QUALIFICATIONS

Required Education

Completion of an accredited Registered Nurse (RN).

Required Experience

1-3 years of hospital or medical clinic experience.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 – $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full TimePosting Date: 11/08/2023

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