Top 488 Rn consultant Jobs in Remote

Care Review Clinician (RN) - Remote in FL
Molina Healthcare, Inc. —Saint Petersburg, FL
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- RN License
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Optum —Plymouth, MN
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Cohere Health —Remote
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Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
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Clinical Claim Review RN
Optum —Boston, MA
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Utilization Review Nurse - RN
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Medical Management - Utilization Management RN 145-2026
CommunityCare —Remote
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CommunityCare —Remote
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Clinical Medical Review Nurse (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
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Clinical Documentation Specialist
City of Hope —Remote
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Firstsource Healthcare —Remote
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Registered Nurse - Freelance AI Trainer Project
Meridial —Remote
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Clinical Documentation Specialist
Managed Resources, Inc (MRI) —Remote
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Utilization Review RN Part- time Day - REMOTE
Providence —Irvine, CA
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Medical Review Nurse
Verse Medical —Remote
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Magicforce —Remote
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12d
PreAuthorization RN
MJHS —New York, NY
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11d
Initial Clinical Reviewer
Enlyte —Remote
- $59,000 - $73,000 a year
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- Clinic experience
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Care Review Clinician (RN) - Remote in FL

Molina Healthcare, Inc. -
Saint Petersburg, FL

Apply Now

Job Details

Full-time
$26.41 - $51.49 an hour

Benefits

Health insurance

Qualifications

Inpatient experience
RN License
Managed care organization experience
Acute care facility experience
Pre-authorization review for utilization management
Productivity software

Full Job Description

JOB DESCRIPTION

Must reside in Florida

Job Summary

Provides support for clinical member services review assessment processes. 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.

Essential Job Duties

Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.

Required Qualifications

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). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.

Utilization Management (UM) experience highly preferred.

#PJHS3

#LI-AC1

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Apply Now

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