RN - Emergency Department (Healthcare)

Behavioral Health experience required.

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.

Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.

• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
• Collaborates with multidisciplinary teams to promote the Molina care model.
• Adheres to utilization management (UM) policies and procedures.

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). Microsoft Office suite/applicable software program(s) proficiency.

Certified Professional in Healthcare Management (CPHM).

• Recent hospital experience in an intensive care unit (ICU) or emergency room.

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.