Care Review Clinician, PA - Cedar Rapids, IA - Molina Healthcare

    Molina Healthcare
    Molina Healthcare Cedar Rapids, IA

    14 hours ago

    Default job background
    Description

    **Utilization Review Registered Nurse Opportunity**

    We are seeking an experienced Utilization Review RN with a compact, multi-state license to join our team in the United States.

    This role involves reviewing prior authorization requests for transplants and requires experience in utilization review or case management for transplants.

    Preferring candidates who have UM experience within another MCO like Molina and those with experience using Interqual/MCG guidelines.

    Responsibilities:

    • Assess services for members to ensure optimum outcomes, cost effectiveness, and compliance with all state and federal regulations and guidelines.
    • Analyze clinical service requests from members or providers against evidence-based clinical guidelines.
    • Identify appropriate benefits and eligibility for requested treatments and/or procedures.
    • Conduct prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
    • Process requests within required timelines.

    Requirements:

    • Completion of an accredited Registered Nurse (RN) degree.
    • 1-3 years of hospital or medical clinic experience.
    • Active, unrestricted State Registered Nursing (RN) license in good standing.

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

    Pay Range: $26.41 - $61.79 / HOURLY

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