Molina Healthcare
Utilization Review Clinician (RN) - OH License
United States
Sponsorship not specifiedDetected 2 days ago
About the role
- 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.
Responsibilities
- Provides support for clinical member services review assessment processes.
Nice to have
- 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.
- Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
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This listing is sourced directly from Molina Healthcare's careers page and normalized into a canonical job model.