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Registered Nurse - Now Hiring

Molina Healthcare12 months ago
Louisville, Kentucky, United States
On-site
Full-time
Junior Level (1-3 years)
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Job Description

Position Overview

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.

Key Responsibilities

  • Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
  • Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
  • Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
  • Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
  • Processes requests within required timelines.
  • Refers appropriate prior authorization requests to Medical Directors.
  • Requests additional information from members or providers in a consistent and efficient manner.
  • Makes appropriate referrals to other clinical programs.
  • Collaborates with multidisciplinary teams to promote Molina Care Model.
  • Adheres to UM policies and procedures.
  • Occasional travel to other Molina offices or hospitals as requested.
  • Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.

Required Qualifications

  • Completion of an accredited Registered Nurse (RN).
  • 1-3 years of hospital or medical clinic experience.
  • Active, unrestricted State Registered Nursing (RN) license in good standing.

Preferred Qualifications

  • Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review/Utilization Management and knowledge of Interqual/MCG guidelines.
  • Active, unrestricted Utilization Management Certification (CPHM).
  • Individual state licensures required for: CA, NV, IL, and MI.
  • Work Schedule: Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.

Benefits & Perks

  • COMPENSATION: Pay Range: $26.41 - $51.49 / HOURLY. Actual compensation may vary based on geographic location, work experience, education and/or skill level.
  • BENEFITS: Molina Healthcare offers a competitive benefits and compensation package.
  • Equal Opportunity Employer (EOE) M/F/D/V

Required Skills

Compliance with Healthcare Regulations
Patient Care Coordination
Interdisciplinary Collaboration
Utilization Review
RN License Management
Acute Care (Hospital/ER/ICU)
Prior Authorization
Clinical Assessment