Kentucky Licensed Care Review Clinician
Job Summary
To support clinical member services, the full-time Kentucky Licensed Care Review Clinician will assess the medical necessity of services, analyze clinical requests, and ensure compliance with established guidelines while working remotely.
Key responsibilities
- Assess services for members to ensure optimal outcomes and compliance with regulations
- Analyze clinical service requests against evidence-based guidelines and determine prior authorization needs
- Collaborate with multidisciplinary teams to promote the integrated 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
- Proficiency in Microsoft Office and applicable software programs
- Strong organizational and critical-thinking skills
- Ability to manage multiple deadlines effectively
Complete Job Description
The complete job description is available to members. Premium membership includes:
Full access to 41,964 remote jobs from human-vetted companies, updated daily
Resume Builder - AI-powered tool to craft, enhance, and tailor your resume to a specific job
Twice-monthly live group coaching and the full Remote Career Center
20% member discount on Career Services
Backed by a 30-day money-back guarantee
Company Company Name
Headquarters Headquarters
Founded Founded
Website
Wikipedia Wikipedia URL
BBB URL BBB URL
The company description is available to members. Go Premium for full access to every job and company profile in our remote jobs database, backed by a 30-day money-back guarantee.
