RN Care Review Clinician

Job Summary

Providing support for clinical member services review assessment processes, the full-time RN Care Review Clinician will verify the medical necessity of services while ensuring compliance with clinical guidelines and regulations to promote quality member care.

Key responsibilities

• Assess services for members to ensure optimum outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based clinical guidelines
• Collaborate with multidisciplinary teams to enhance 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
• Proficiency in Microsoft Office suite and applicable software programs
• Ability to prioritize and manage multiple deadlines effectively
• Strong organizational and critical-thinking skills