Care Review Clinician (RN) - Remote

Overview

The Care Review Clinician at Molina Healthcare Services is responsible for assessing and coordinating care for members with high need potential, ensuring quality and cost-effective healthcare delivery.

In Short

• Remote position requiring a New York RN license.
• Work schedule: Monday - Friday, with occasional weekends.
• Assess services for members to ensure optimum outcomes.
• Analyze clinical service requests against evidence-based guidelines.
• Conduct prior authorization reviews for treatment eligibility.
• Collaborate with multidisciplinary teams.
• Must adhere to UM policies and procedures.
• Occasional travel may be required for internal meetings.
• 1-3 years of hospital or clinic experience required.
• Active RN license in good standing is mandatory.

Requirements

• Completion of an accredited Registered Nurse (RN) program.
• 1-3 years of relevant experience in healthcare.
• Experience with managed care and Medicaid guidelines preferred.
• Ability to work independently in a high-volume environment.
• Strong analytical and communication skills.
• Reliable transportation for potential travel.

Benefits

• Competitive benefits and compensation package.
• Equal Opportunity Employer.