Molina Healthcare Services (HCS) works with members, providers
and multidisciplinary team members to assess, facilitate, plan and
coordinate an integrated delivery of care across the continuum,
including behavioral health and long term care, for members with
high need potential. HCS staff work to ensure that patients
progress toward desired outcomes with quality care that is
medically appropriate and cost-effective based on the severity of
illness and the site of service.
• Assesses inpatient 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, eligibility and expected
length of stay for requested treatments and/or procedures.
• Conducts inpatient reviews to determine financial
responsibility for Molina Healthcare and its members. May also
perform prior authorization reviews and/or related duties as
• Processes requests within required timelines.
• Refers appropriate cases to Medical Directors and presents
them in a consistent and efficient manner.
• 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
• Adheres to UM policies and procedures.
• Occasional travel to other Molina offices or hospitals as
requested, may be required. This can vary based on the individual
Graduate from an Accredited School of Nursing.
3+ years hospital acute care/medical experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in
Must have valid driver's license with good driving record and be
able to drive within applicable state or locality with reliable
Bachelor's Degree in Nursing
Recent hospital experience in ICU, Medical, or ER unit.
Preferred License, Certification, Association
Utilization Management Certification (CPHM).
To all current Molina employees: If you are interested in
applying for this position, please apply through the intranet job
Molina Healthcare offers a competitive benefits and compensation
package. Molina Healthcare is an Equal Opportunity Employer (EOE)