RN Care Review Clinician

Job Summary

Supporting Medicaid members during their transition from inpatient care, the full-time RN Care Review Clinician will conduct assessments, verify service necessity, and collaborate with multidisciplinary teams in a remote setting.

Key responsibilities

• Assesses services for members to ensure optimum outcomes and compliance with 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
• Proficiency in Microsoft Office suite and applicable software programs
• Ability to prioritize and manage multiple deadlines
• Strong organizational and critical-thinking skills