Prior Authorization-Utilization Review Nurse-Must be CA licensed RN-Remote

Care Review Clinician (UM RN) Large Managed Care Company

Fully Remote

3-month contract-Strong potential for extension and/or perm hire

3 full-time positions to fill

Must be a licensed RN in CA

Rotating schedule Sun-Sat 6am-6pm PST

Schedules will be monthly and flexible

up to $46 an hour

Day to Day Responsibilities: Medical necessity clinical review or services requiring prior authorization
Must Have Requirements: Health Plan or IPA experience performing prior authorization review, CA RN license

KNOWLEDGE/SKILLS/ABILITIES

• 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 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.

#ALLJ

Pay: Up to $46.00 per hour

Expected hours: 40.0 per week

Benefits:

• 401(k)
• Health insurance

Work Location: Remote