California Licensed Care Review RN

Job Summary

To support clinical member services, the full-time California Licensed Care Review RN will assess service requests for medical necessity, analyze clinical guidelines, and ensure compliance with regulations while working remotely.

Key responsibilities

• Assesses services for members to ensure optimum outcomes and compliance with state/federal regulations
• Analyzes clinical service requests against evidence-based clinical guidelines
• Collaborates with multidisciplinary teams to promote the Molina care model

Required qualifications

• At least 2 years of experience in hospital acute care, inpatient review, or managed care
• Active and unrestricted Registered Nurse (RN) license in the state of practice
• Ability to prioritize and manage multiple deadlines
• Proficiency in Microsoft Office suite and applicable software programs
• Strong organizational and critical-thinking skills