RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Read straight from Molina Healthcare's careers page, verified 15h ago.Seekless can tailor your résumé to it.
Seekless can write your résumé for this posting first.
Before you apply
Salary$30 – $59/hr
LocationCA, United States
Work moderemote
Typefull-time
SeniorityMid
Experience2+ yrs
DepartmentClinical
Company size10,000+ people
First seenOct 17, 2026 · 2w ago
Verified live15h ago
At a glanceSummarised by Seekless from the posting.
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
Certified Professional in Healthcare Management (CPHM)
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred
Skills
Microsoft Office
Benefits
Health insurance
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Job Description
JOB DESCRIPTION
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).
• Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred.
• To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Additional Information
• Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Job Info
•
Job Identification: 2036930
•
Job Category: Clinical
•
Posting Date: 07/29/2026, 07:47 PM
•
Job Schedule: Full time
•
Locations: CA, United States; San Francisco, CA, United States; Los Angeles, CA, United States; San Jose, CA, United States; San Diego, CA, United States; Sacramento, CA, United States
•
Salary Range: $30.37 - $59.21 Hourly *Actual compensation may vary based on geographic location, work experience, education and/or skill level
More roles at Molina Healthcare