Job Summary Molina Healthcare Services (HCS) is seeking a skilled Care Review Clinician to join our team of dedicated professionals. As a Care Review Clinician, you will play a vital role in assessing, facilitating, planning, and coordinating integrated care delivery across the continuum, including behavioral health and long-term care, for members with high need potential. Our team works collaboratively to ensure patients receive quality care that is medically appropriate and cost-effective, based on the severity of illness and site of service. Key Responsibilities Conduct comprehensive assessments to ensure optimal outcomes, cost-effectiveness, and compliance with state and federal regulations and guidelines. Analyze clinical service requests against evidence-based clinical guidelines to determine medical necessity and identify appropriate benefits and eligibility. Perform prior authorization reviews to determine financial responsibility for Molina Healthcare and its members, and process requests within required timelines. Collaborate with multidisciplinary teams to promote the Molina Care Model and adhere to Utilization Management (UM) policies and procedures. Make referrals to other clinical programs and request additional information from members or providers in a consistent and efficient manner. Requirements Completion of an accredited Registered Nurse (RN) program. 1-3 years of hospital or medical clinic experience. Active, unrestricted State Registered Nursing (RN) license in good standing. What We Offer Molina Healthcare provides a competitive benefits and compensation package, with an hourly pay range of $26.41 - $61.79. Actual compensation may vary based on geographic location, work experience, education, and/or skill level. We are an Equal Opportunity Employer (EOE) M/F/D/V. Apply Now! or to join our team of dedicated healthcare professionals. Apply for this job