Molina Healthcare

Molina Healthcare

Medical Review Nurse (RN)- Post Appeals (must be licensed in Illinois)

United States

Sponsorship not specifiedDetected 2 days ago
AuditingICD-10CommunicationProblem SolvingMicrosoft Office

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odds of building a lasting career here

31Risky
Cap-exempt (no lottery)0
Sponsors this role58
Entry-level history0
PERM / green-card track0
Lottery odds40
Fits your clock70

Thin sponsorship signal and lottery-bound. A low-probability bet with your clock running. Prioritize cap-exempt roles and proven entry-level sponsors first.

Lottery odds assume a STEM candidate.

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Employer immigration record

from this employer's Department of Labor filings

Green-card filing pattern in this occupation

Context, not a finding about this posting: of this employer's 7 green-card filings in this occupation, 100% were for a worker who already held the job.

Green-card follow-through: 40%

Of 5 labor certifications old enough to have been used, 3 expired without the employer filing the next step. Median time from filing to decision: 500 days.100% of their filings were for a worker who already held the job.Only certifications past the 180-day window are counted — recent ones cannot have expired yet.

Files H-1B transfers

2 transfer filings in the last year, covering 2 workers. Median labor-condition decision: 8 days. An employer that already files transfers is one that can take over an existing H-1B.

Sourced from Department of Labor LCA, PERM and prevailing-wage disclosure data. Employer matching is by name, so figures may be split across an employer's legal entities. Absence of a filing means none appears in our copy of the data, not that none exists.

Community outcomes

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About the role

  • Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies
  • Facilitates medical review of prospective, retrospective, and concurrent review of appeals for denied prior authorizations.
  • Includes standard and expedited cases, inpatient, outpatient, and pharmaceutical authorization appeals.

Responsibilities

  • Provides training and support to clinical peers.

Requirements

  • License must be active and unrestricted in state of practice.
  • Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and
  • Experience working within applicable state, federal, and third-party regulations.
  • Common look proficiency.
  • Microsoft Office suite and applicable software program(s) proficiency.

Nice to have

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

Compensation

  • Molina Healthcare offers a competitive benefits and compensation package.

Benefits

  • validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
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This listing is sourced directly from Molina Healthcare's careers page and normalized into a canonical job model.