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.
• Analyzes clinical service requests from members or providers
against evidence based clinical guidelines.
• 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.
• Under the direction of an Registered Nurse, identifies
appropriate benefits, eligibility and expected length of stay for
requested treatments and/or procedures.
• 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.
Qualifications Job Qualifications
Graduate from an Accredited School of Nursing. Associate's
Degree in Nursing preferred.
3+ years hospital acute care/medical experience.
Required License, Certification, Association
Active, unrestricted State Licenses Practical Nurse (LPN) or
Licensed Vocational Nurse (LVN) license in good standing.
Recent hospital experience in Medical or ER unit.
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)