About the position
The Utilization Review RN position at Molina Healthcare involves joining the inpatient review team to conduct initial and concurrent reviews, with opportunities for cross-training in prior authorization reviews. The role focuses on assessing and coordinating care for members with high needs, ensuring compliance with regulations, and promoting cost-effective healthcare delivery.
Responsibilities
• Conduct initial and concurrent reviews of inpatient services to ensure optimum outcomes and compliance with regulations.
• Analyze clinical service requests against evidence-based clinical guidelines.
• Identify appropriate benefits, eligibility, and expected length of stay for requested treatments or procedures.
• Process requests within required timelines and refer cases to Medical Directors as necessary.
• Collaborate with multidisciplinary teams to promote the Molina Care Model.
• Request additional information from members or providers efficiently.
• Perform prior authorization reviews and related duties as needed.
Requirements
• Graduate from an Accredited School of Nursing.
• 3+ years of hospital acute care/medical experience.
• Active, unrestricted State Registered Nursing (RN) license in good standing.
• Valid driver's license with a good driving record.
Nice-to-haves
• Bachelor's Degree in Nursing
• Recent hospital experience in ICU, Medical, or ER unit.
• Active, unrestricted Utilization Management Certification (CPHM).
Benefits
• Competitive benefits and compensation package.
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