Care Review Clinician (RN) (Must work PST hours)Molina Healthcare • Provo, UT, US
Care Review Clinician (RN) (Must work PST hours)
Molina Healthcare • Provo, 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 • Provo, UT, US
Job_description.internal_linking.related_jobs
Description Ideal Candidate must be willing to work at least 50% night shift Introduction Do you have the PRN career opportunities as a(an) RN NICU PRN you want with your current employer? We have ...serp_jobs.internal_linking.show_more
Axis Medical Staffing is seeking an experienced CT Tech for an exciting Travel Allied job in Payson, UT.Shift : Inquire Start Date : ASAP Duration : 13 weeks.
TOP RANKED TRAVEL NURSING COMPANY IN THE N...serp_jobs.internal_linking.show_more
HealthTrust Workforce Solutions Local is seeking a per diem / prn nurse RN ICU - Intensive Care Unit for a per diem / prn nursing job in Orem, Utah.
Job Description & Requirements.Posted rates refle...serp_jobs.internal_linking.show_more
A Registered Floor Nurse (RN) provides direct care to residents and is a critical part of the healthcare team.Working as part of a team, you will assess, plan, implement, and evaluate resident care...serp_jobs.internal_linking.show_more
We are actively looking to hire talented Therapists in Utah - Murray, (Greater Salt.Lake City area) who are passionate about patient care and committed to clinical excellence.We are looking to hire...serp_jobs.internal_linking.show_more
LRS Healthcare - Allied is seeking an experienced MRI Tech for an exciting Travel Allied job in Payson, UT.Shift : Inquire Start Date : ASAP Duration : 11 weeks Pay : $2272 / Week.Ready to start your n...serp_jobs.internal_linking.show_more
Host Healthcare is seeking an experienced MRI Tech for an exciting Travel Allied job in Payson, UT.Shift : Inquire Start Date : 12 / 02 / 2025 Duration : 13 weeks Pay : $2374 / Week.At Host Healthcare, we ...serp_jobs.internal_linking.show_more
HealthTrust Workforce Solutions Local is seeking a per diem / prn nurse RN Telemetry for a per diem / prn nursing job in Orem, Utah.
Job Description & Requirements.Entrust Your Career to HealthT...serp_jobs.internal_linking.show_more
Medpro Healthcare Staffing is seeking an experienced MRI Tech for an exciting Travel Allied job in Payson, UT.Shift : 5x8 hr PMs Start Date : 12 / 15 / 2025 Duration : 13 weeks Pay : $2476 / Week.Joint Com...serp_jobs.internal_linking.show_more
GHR Healthcare - PH Division is seeking a travel MRI Technologist for a travel job in Payson, Utah.Job Description & Requirements.
Planet Healthcare Job ID #73570329.Pay package is based on 8 ho...serp_jobs.internal_linking.show_more
Core Medical Group is seeking a travel Skilled Nursing Facility (SNF) Certified Occupational Therapy Assistant for a travel job in Holladay, Utah.
Job Description & Requirements.Certified Occupa...serp_jobs.internal_linking.show_more 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 c...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
Registered Nurse (RN) - Full-Time Days.Cascades at Orchard Park | Orem, UT.Are you a nurse who wants to feel valued, supported, and part of a team that truly makes a difference? At.Here, you'll fin...serp_jobs.internal_linking.show_more
Host Healthcare is seeking a travel MRI Technologist for a travel job in Payson, Utah.Job Description & Requirements.Pay package is based on 8 hour shifts and 40 hours per week (subject to conf...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 Description Introduction Do you have the PRN career opportunities as a(an) RN CVOR PRN you want with your current employer? We have an exciting opportunity for you to join St.Mark's Hospital which ...serp_jobs.internal_linking.show_more 
Fusion Medical Staffing is seeking an experienced MRI Tech for an exciting Travel Allied job in Payson, UT.Shift : Inquire Start Date : ASAP Duration : 13 weeks Pay : $2451 / Week.Fusion Medical Staffi...serp_jobs.internal_linking.show_more
RN NICU PRN
St. Mark's Hospital • Holladay, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel CT Tech
Axis Medical Staffing • Payson, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Per Diem / PRN Nurse RN - ICU - Intensive Care Unit - $59 per hour
HealthTrust Workforce Solutions Local • Orem, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Registered Floor Nurse (RN)
Larry H. Miller Senior Health • Orem, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Licensed Mental Health Therapist (LCSW, LMFT or CMHC) for a growing Outpatient practice!
LifeStance Health • Spanish Fork, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel MRI Tech - $2272 / Week
LRS Healthcare - Allied • Payson, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel MRI Tech - $2374 / Week
Host Healthcare • Payson, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Per Diem / PRN Nurse RN - Telemetry - $59 per hour
HealthTrust Workforce Solutions Local • Orem, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Travel MRI Tech - $2476 / Week
Medpro Healthcare Staffing • Payson, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel MRI Technologist
GHR Healthcare - PH Division • Payson, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel Certified Occupational Therapy Assistant (COTA)
Core Medical Group • Holladay, UT, US
serp_jobs.job_card.permanent +1
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Care Review Clinician (RN) (Must work PST hours)
Molina Healthcare • Vineyard, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
Clinical Nurse, PRN
University of Utah Health • Orem, UT, United States
serp_jobs.job_card.permanent
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Registered Nurse (RN) Full Time Days
Cascades at Orchard Park • Orem, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel MRI Technologist
Host Healthcare • Payson, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • 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 • Provo, Utah, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
RN CVOR PRN
St. Mark's Hospital • Holladay, UT, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel MRI Tech - $2451 / Week
Fusion Medical Staffing • Payson, UT, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted