Remote Registered Nurse (RN) - Utilization Management

Overview

The qualified candidate must be licensed as a RN for the state of NEVADA and will work PACIFIC business hours. 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.

In Short

• Assess inpatient services for optimum outcomes and compliance.
• Analyze clinical service requests against evidence-based guidelines.
• Identify benefits, eligibility, and expected length of stay for treatments.
• Conduct inpatient reviews for financial responsibility.
• Process requests within required timelines.
• Refer cases to Medical Directors efficiently.
• Request additional information from members or providers.
• Make referrals to other clinical programs.
• Collaborate with multidisciplinary teams.
• Adhere to UM policies and procedures.

Requirements

• Graduate from an Accredited School of Nursing.
• 3+ years hospital acute care/medical experience.
• Active, unrestricted State Registered Nursing (RN) license.
• Licensed within the state of Illinois or apply for licensure in NEVADA.
• Bachelor's Degree in Nursing preferred.
• Recent hospital experience in ICU, Medical, or ER unit preferred.
• Prior experience with InterQual or MCG guidelines preferred.
• Utilization Management Certification (CPHM) preferred.

Benefits

• Competitive benefits and compensation package.
• Equal Opportunity Employer (EOE) M/F/D/V.