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Job description
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Molina Healthcare Services (HCS) works with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high-need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
Responsibilities include:
Conduct inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.
Refer appropriate cases to Medical Directors and present them in a consistent and efficient manner.
Collaborate with multidisciplinary teams to promote the Molina Care Model.
Adhere to Utilization Management (UM) policies and procedures.
Occasional travel to other Molina offices or hospitals as requested.
Qualifications:
Graduate from an Accredited School of Nursing.
3+ years hospital acute care/medical experience.
Active, unrestricted State Registered Nursing (RN) license in good standing.
Previous experience in Hospital Acute Care, ER, or ICU, Prior Authorization, Utilization Review / Utilization Management, and knowledge of Interqual / MCG guidelines.
Schedule: Mon - Fri / Sun - Thurs / Tues - Sat shift, rotating with some weekends and holidays.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Compensation: $49/hour (actual compensation may vary based on geographic location, work experience, education, and/or skill level).
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Worksite address
omaha, NE, 68197, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.