Join Our Team: RN Inpatient Review Case Manager for California Health Plan
At Molina Healthcare Services, we're dedicated to delivering high-quality, cost-effective care to our members. As a leading healthcare organization, we're seeking an experienced RN Inpatient Review Case Manager to join our team in California. This is a unique opportunity to work remotely and make a meaningful impact on the lives of our members. If you're a motivated and compassionate nurse with a passion for utilization management, we encourage you to apply.
About Molina Healthcare Services
Molina Healthcare Services (HCS) is a pioneering healthcare organization that works closely with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate integrated care across the continuum. Our goal is to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective. We operate 24/7/365 days a year, and our team is committed to delivering exceptional care and support to our members.
Job Summary
We're seeking an experienced RN Inpatient Review Case Manager to support our California Health Plan. As a key member of our team, you'll be responsible for assessing inpatient services, analyzing clinical service requests, and identifying appropriate benefits and eligibility for requested treatments and procedures. If you have a strong background in utilization management, case management, and a passion for delivering high-quality care, we encourage you to apply.
Key Responsibilities
- Assess inpatient services for members to ensure optimum outcomes, cost-effectiveness, and compliance with state and federal regulations and guidelines.
- Analyze clinical service requests from members or providers against evidence-based clinical guidelines.
- Identify appropriate benefits, eligibility, and expected length of stay for requested treatments and/or procedures.
- Conduct inpatient reviews to determine financial responsibility for Molina Healthcare and its members.
- Process requests within required timelines and refer appropriate cases to Medical Directors.
- Collaborate with multidisciplinary teams to promote the Molina Care Model and adhere to UM policies and procedures.
- Occasional travel to other Molina offices or hospitals may be required.
Requirements and Qualifications
Essential Qualifications:
- Graduate from an Accredited School of Nursing.
- 3+ years of hospital acute care/medical experience.
- Prior experience in Managed care using Interqual or MCG guidelines.
- Active, unrestricted State Registered Nursing (RN) license in California.
Preferred Qualifications:
- Bachelor's Degree in Nursing.
- Recent hospital experience in ICU, Medical, or ER unit.
- Active, unrestricted Utilization Management Certification (CPHM).
Skills and Competencies
To succeed in this role, you'll need:
- Excellent analytical and critical thinking skills.
- Strong communication and interpersonal skills.
- Ability to work independently and collaboratively as part of a multidisciplinary team.
- Proficiency in utilization management guidelines and regulations.
- Strong organizational and time management skills.
What We Offer
At Molina Healthcare Services, we're committed to delivering an exceptional employee experience. Here are just a few benefits and perks we offer:
- Competitive salary range: $23.76 - $51.49 per hour.
- Comprehensive benefits package, including medical, dental, and vision coverage.
- Opportunities for professional growth and development.
- Flexible work arrangements, including remote work options.
- Recognition and reward programs for outstanding performance.
Work Environment and Culture
At Molina Healthcare Services, we're proud of our inclusive and supportive work environment. Here are just a few highlights:
- We're a diverse and inclusive organization that values different perspectives and experiences.
- We prioritize employee well-being and offer a range of wellness programs and resources.
- We're committed to delivering high-quality care and support to our members.
- We offer opportunities for professional growth and development.
How to Apply
If you're a motivated and compassionate nurse with a passion for utilization management, we encourage you to apply for this exciting opportunity. Please click the link below to submit your application:
Apply Now
Conclusion
At Molina Healthcare Services, we're dedicated to delivering high-quality, cost-effective care to our members. We're seeking an experienced RN Inpatient Review Case Manager to join our team in California and make a meaningful impact on the lives of our members. If you're a motivated and compassionate nurse with a passion for utilization management, we encourage you to apply for this exciting opportunity.
Apply Now