Clinical Social Worker jobs at Molina Healthcare - 23 jobs

we are seeking a (RN) Registered Nurse who must hold a compact license. , home office with internet connectivity of high speed required Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides 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. Essential Job Duties * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes 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. Required Qualifications * 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. Preferred Qualifications * Certified Professional in Healthcare Management (CPHM). * Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. McKesson is in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. McKesson Medical-Surgical provides medical-surgical supplies and equipment to physicians' offices, home care agencies, long-term care facilities and surgery centers. Our catalog includes more than 150,000 national brand products from bandages to exam tables, plus McKesson's own line of high-quality medical-surgical products. We're proud to be the only national distributor serving the entire continuum of healthcare. Every single McKesson employee contributes to our mission-by joining McKesson Medical-Surgical you act as a catalyst in a chain of events that helps millions of people all over the globe. Your expertise, drive and passion can help us improve everything we touch, from providers to payors to pharmacies. You'll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that's vital to us all. Join our team of leaders to begin a rewarding career. Position Summary Under general supervision, the Associate Social Worker provides remote generalist social work duties to include knowledge of and referrals to agencies and organizations offering emotional, physical, social, and financial services to patients and families. This entry level team member works collaboratively with the Innovent team, as well as the Texas Oncology team. Top Requirements For Consideration LBSW: Degreed in Social Work Licensed in the state of Texas Living in the state of Texas Key Responsibilities Provides information & helps coordinate access to resources and services for patients, families, and/or caregivers, making appropriate referrals as needed. Completes patient forms when necessary (i.e. patient disability forms, indigent drug program, etc.). May administer psychosocial needs assessments, distress and depression screens to patients and families, and then forward the assessments needing evaluation to the appropriate, identified clinicians. Acts as a patient/family advocate in negotiating the health care system. Relays identified patient and family needs to medical team members. Documents all tasks in EMR accurately, appropriately, and timely. Develops and maintains working relationships with community agencies, health care organizations, and other providers to promote a broad base of support for patients and families. Minimum Requirement Typically, minimum 0-2 years of relevant experience. May have degree or equivalent. Education Bachelor's degree in social work from a school or program accredited by the Council on Social Work Education (CSWE). Appropriate Texas state licensure required Critical Skills 0-2 years social work experience in a healthcare setting, oncology experience highly preferred Demonstrated knowledge of age-specific differences in the patient population that include late adolescence, adulthood, middle age, and the elderly (includes physiological, psychological, and developmental differences unique to each group) Must be able to work remote and have dedicated space for workstation and highspeed internet in place Must have audio and camera capabilities for meeting with patients and families Working Conditions Remote - work from home Work schedule Mon - Fri, 40 hours/week We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Base Pay Range for this position $24.05 - $40.08 McKesson has become aware of online recruiting-related scams in which individuals who are not affiliated with or authorized by McKesson are using McKesson's (or affiliated entities, like CoverMyMeds or RxCrossroads) name in fraudulent emails, job postings or social media messages. In light of these scams, please bear the following in mind: McKesson Talent Advisors will never solicit money or credit card information in connection with a McKesson job application. McKesson Talent Advisors do not communicate with candidates via online chatrooms or using email accounts such as Gmail or Hotmail. Note that McKesson does rely on a virtual assistant (Gia) for certain recruiting-related communications with candidates. McKesson job postings are posted on our career site: careers.mckesson.com. McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age, genetic information, or any other legally protected category. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Evaluates member's treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and their families regrading BH utilization process Interacts with BH healthcare providers as appropriate to discuss level of care and/or services Engages with medical directors and leadership to improve the quality and efficiency of care Formulates and presents cases in staffing and integrated rounds Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 - 4 years of related experience. License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred. License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required For Fidelis Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

For this position we are seeking a RN with a current active license for state of KY and or compact licensure The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and inpatient services for the KY Medicaid behavioral health population. Strong post-acute level of care experience (Nursing Facilities, Acute Inpatient, Rehabilitation, Long Term Acute care hospital, Behavioral Health Facility. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good analytical thought process is important to be successful in this role. Prefer candidates that have experience doing prior authorizations for outpatient services preferrable within Behavioral Health Population. WORK SCHEDULE: Monday thru Friday 8:00 AM to 5:00 PM EST - Training Schedule (30 to 60 days) Permanent schedule will require you to work 4 to 5 days a week - with one weekend day required (Saturday, Sunday (either one or both)) This is a Remote position, home office with internet connectivity of high speed required. Job Summary 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. Essential Job Duties - Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. - Analyzes 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. Required Qualifications - 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. Preferred Qualifications - Certified Professional in Healthcare Management (CPHM). - Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job SummaryProvides 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. Essential Job Duties - Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. - Analyzes 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. Required Qualifications - 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. Preferred Qualifications - Certified Professional in Healthcare Management (CPHM). - Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

we are seeking a (RN) Registered Nurse who must hold a compact license. , home office with internet connectivity of high speed required Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides 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. Essential Job Duties - Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. - Analyzes 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. Required Qualifications - 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. Preferred Qualifications - Certified Professional in Healthcare Management (CPHM). - Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes 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. Required Qualifications • 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. Preferred Qualifications *Behavioral Health nursing experience- inpatient psychiatric, IMD, Residential SUD, IOP, PHP To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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. Essential Job Duties * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes 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. Required Qualifications * 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. Preferred Qualifications * Behavioral Health nursing experience- inpatient psychiatric, IMD, Residential SUD, IOP, PHP To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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. Essential Job Duties - Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. - Analyzes 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. Required Qualifications - 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. Preferred Qualifications *Behavioral Health nursing experience- inpatient psychiatric, IMD, Residential SUD, IOP, PHP To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

we are seeking a (RN) Registered Nurse who must hold a compact license. , home office with internet connectivity of high speed required Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides 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. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes 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. Required Qualifications • 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. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

we are seeking a (RN) Registered Nurse who must hold a compact license. , home office with internet connectivity of high speed required Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides 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. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes 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. Required Qualifications • 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. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

we are seeking a (RN) Registered Nurse who must hold a compact license. , home office with internet connectivity of high speed required Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides 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. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes 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. Required Qualifications • 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. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

For this position we are seeking a RN with a current active license for state of KY and or compact licensure The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and inpatient services for the KY Medicaid behavioral health population. Strong post-acute level of care experience (Nursing Facilities, Acute Inpatient, Rehabilitation, Long Term Acute care hospital, Behavioral Health Facility. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good analytical thought process is important to be successful in this role. Prefer candidates that have experience doing prior authorizations for outpatient services preferrable within Behavioral Health Population. WORK SCHEDULE: Monday thru Friday 8:00 AM to 5:00 PM EST - Training Schedule (30 to 60 days) Permanent schedule will require you to work 4 to 5 days a week - with one weekend day required (Saturday, Sunday (either one or both)) This is a Remote position, home office with internet connectivity of high speed required. Job Summary 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. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes 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. Required Qualifications • 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. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

we are seeking a (RN) Registered Nurse who must hold a compact license. , home office with internet connectivity of high speed required Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides 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. Essential Job Duties * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes 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. Required Qualifications * 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. Preferred Qualifications * Certified Professional in Healthcare Management (CPHM). * Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

we are seeking a (RN) Registered Nurse who must hold a compact license. , home office with internet connectivity of high speed required Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides 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. Essential Job Duties * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes 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. Required Qualifications * 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. Preferred Qualifications * Certified Professional in Healthcare Management (CPHM). * Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

For this position we are seeking a RN with a current active license for state of KY and or compact licensure The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and inpatient services for the KY Medicaid behavioral health population. Strong post-acute level of care experience (Nursing Facilities, Acute Inpatient, Rehabilitation, Long Term Acute care hospital, Behavioral Health Facility. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good analytical thought process is important to be successful in this role. Prefer candidates that have experience doing prior authorizations for outpatient services preferrable within Behavioral Health Population. WORK SCHEDULE: Monday thru Friday 8:00 AM to 5:00 PM EST - Training Schedule (30 to 60 days) Permanent schedule will require you to work 4 to 5 days a week - with one weekend day required (Saturday, Sunday (either one or both)) This is a Remote position, home office with internet connectivity of high speed required. Job Summary 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. Essential Job Duties - Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. - Analyzes 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. Required Qualifications - 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. Preferred Qualifications - Certified Professional in Healthcare Management (CPHM). - Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. Essential Job Duties * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes 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. Required Qualifications * 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. Preferred Qualifications * Behavioral Health nursing experience- inpatient psychiatric, IMD, Residential SUD, IOP, PHP To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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. Essential Job Duties * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes 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. Required Qualifications * 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. Preferred Qualifications * Behavioral Health nursing experience- inpatient psychiatric, IMD, Residential SUD, IOP, PHP To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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. Essential Job Duties * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes 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. Required Qualifications * 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. Preferred Qualifications * Behavioral Health nursing experience- inpatient psychiatric, IMD, Residential SUD, IOP, PHP To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.