Care Review Clinician (RN) (Must work PST hours)Molina Healthcare • Layton, UT, US
serp_jobs.error_messages.no_longer_accepting
Care Review Clinician (RN) (Must work PST hours)
Molina Healthcare • Layton, UT, US
job_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_descriptionAnalyzes clinical service requests from members or providers against evidence based clinical guidelines. Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and / or procedures. Conducts reviews to determine prior authorization / financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. Requests additional information from members or providers as needed. Makes appropriate referrals to other clinical programs. Collaborates with multidisciplinary teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures. At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to prioritize and manage multiple deadlines. Excellent organizational, problem-solving and critical-thinking skills. Strong written and verbal communication skills. Microsoft Office suite / applicable software program(s) proficiency. Certified Professional in Healthcare Management (CPHM). Recent hospital experience in an intensive care unit (ICU) or emergency room. Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
Job Description
JOB DESCRIPTION Job Summary \n
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
\n
Essential Job Duties \n
\n
- Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state / federal regulations and guidelines.
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
Required Qualifications \n
\n
\n
\n
\n
\n
\n
\n
Preferred Qualifications \n
\n
\n
\n To all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board.
\n 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
serp_jobs.job_alerts.create_a_job
Care Review Clinician • Layton, UT, US
Job_description.internal_linking.related_jobs
The Community Care RN provides and supervises professional, independent nursing care for Providence patients.Care is based in the nursing process and is consistent with the Oregon Nurse Practice Ac...serp_jobs.internal_linking.show_more RN - Intermediate Care Unit (IMCU) at Providence St.FTE, night shift openings (7pm-7 : 30am, 3, 12 hour shifts per week) with rotating weekends and holidays.
Night shift differential - $10 p / hr.Weeken...serp_jobs.internal_linking.show_more 
LocumJobsOnline is working with All Medical Personnel to find a qualified Family Practice NP in Northern Utah, Utah, 84054!.
Outpatient Corporate Health and Wellness For Employees and Family Members...serp_jobs.internal_linking.show_more
Travel Rehab : Physical Therapy West Haven.Shift Details : 8H Days (12 : 00 AM-12 : 00 PM).Length : 13 WEEKS 13 weeks.Apply for specific facility details.serp_jobs.internal_linking.show_more
CRNA- Certified RN Anesthetist.Schedule includes days, nights, weekends and holidays.Priority Review Date (Note - Posting may close at any time).
As a patient-focused organization, the University of...serp_jobs.internal_linking.show_more
Quickly and accurately assess patient care needs.Work collaboratively with doctors and staff to provide exceptional care.
Perform all requested diagnostic tests.Diagnose and develop treatment plans ...serp_jobs.internal_linking.show_more
TravelNurseSource is working with Prime Time Healthcare to find a qualified ICU / Critical Care RN in Vernal, Utah, 84078!.
Now Hiring : RN ICU - Vernal, UT.Contact us for Pay Information.Actual amount...serp_jobs.internal_linking.show_more
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education.
Success in this mission requires a cu...serp_jobs.internal_linking.show_more
Description Introduction Do you have the PRN career opportunities as a(an) Outpatient Cancer Treatment RN PRN you want with your current employer? We have an exciting opportunity for you to join Og...serp_jobs.internal_linking.show_more
Do you have the PRN career opportunities as a(an) RN PACU PRN you want with your current employer? We have an exciting opportunity for you to join Lone Peak Hospital which is part of the nation's l...serp_jobs.internal_linking.show_more
By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected.
We invite you to grow your c...serp_jobs.internal_linking.show_more
Care Team Solutions is seeking a travel Physical Therapist for a travel job in Ogden, Utah.Job Description & Requirements.
Registered Nurse must have 2+ years of recent experience in particular ...serp_jobs.internal_linking.show_more
American Traveler is seeking a travel Physical Therapist for a travel job in Ogden, Utah.Job Description & Requirements.American Traveler is seeking a Physical Therapist with at least 6 months ...serp_jobs.internal_linking.show_more
Core Medical Group is seeking a travel Physical Therapist for a travel job in Ogden, Utah.Job Description & Requirements.
Client in UT seeking Physical Therapist.We are looking for a healthcare ...serp_jobs.internal_linking.show_more
AlliedTravelCareers is working with Triage Staffing LLC to find a qualified Physical Therapist (PT) in West Haven, Utah, 84401!.
Travel Rehab : Physical Therapy West Haven.Shift Details : 8H Days (1...serp_jobs.internal_linking.show_more
Last year alone, HCA Healthcare colleagues invested over 156,000 hours impacting our communities.As a(an) ICU Manager Critical Care RN with St.
Mark's Hospital, you can be a manager in an organizati...serp_jobs.internal_linking.show_more Description This is an Inpatient Wound Care position Introduction Do you have the PRN career opportunities as a(an) Wound Care RN PRN you want with your current employer? We have an exciting opport...serp_jobs.internal_linking.show_more 
Become a part of our caring community and help us put health first.The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, env...serp_jobs.internal_linking.show_more
RN - PACE
Providence Health and Services • Salt Lake City, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
RN - IMCU
Providence Health and Services • Salt Lake City, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Locum Nurse Practitioner (NP) - Family Practice in Northern Utah, UT
LocumJobsOnline • Northern Utah, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Travel Physical Therapist (PT) - $2,087 per week in West Haven, UT
Triage Staffing LLC • West Haven, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
CRNA- Certified RN Anesthetist
University of Utah • Salt Lake City, UT, United States
serp_jobs.job_card.full_time +1
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
RN
Penn Highlands Clearfield • Clearfield, Utah, USA
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel Nurse RN - Intensive Care Unit (ICU) / Critical Care - $1,822 to $2,037 per week in Vernal, UT
TravelNurseSource • West Valley City, Utah, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Critical Care RN
University of Utah Health • Salt Lake City, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Outpatient Cancer Treatment RN PRN
Ogden Regional Medical Center • Washington Terrace, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
RN PACU PRN
Lone Peak Hospital • Draper, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
RN Clinical Consultation
Sedgwick • Salt Lake City, UT, United States
serp_jobs.job_card.part_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel Physical Therapist - Acute Rehabilitation
Care Team Solutions • Ogden, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel Physical Therapist - Acute Rehabilitation
American Traveler • Ogden, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel Physical Therapist - Acute Rehabilitation
Core Medical Group • Ogden, UT, US
serp_jobs.job_card.permanent +1
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel Physical Therapist (PT) - $2,087 per week in West Haven, UT
AlliedTravelCareers • West Haven, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Manager ICU Critical Care RN
St. Mark's Hospital • Salt Lake City, UT, US
serp_jobs.job_card.full_time +1
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Inpatient Wound Care RN PRN
Ogden Regional Medical Center • Washington Terrace, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
RN Care Manager - Remote, nationwide
Humana • Salt Lake City, UT, United States
serp_jobs.filters.remote
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted