![Molina Healthcare](https://contents.bebee.com/companies/us/molina-healthcare/avatar-YPH3y.png)
Remote Telephonic Care Review Clinician, PA
3 weeks ago
JOB DESCRIPTION
We are seeking a (RN) Registered Nurse who resides in and is licensed in the state of Nebraska. This position supports our Prior Authorization review process with our Nebraska Medicaid Health Plan. Strong experience with utilization management, preferably working on the managed care side, is preferred. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role; this is a metrics driven structure. Good analytical thought process is important to be successful in this role.
WORK SCHEDULE: Monday thru Friday 8:00AM to 5:00PM CST (May be required to do some overtime on weekends depending on business need)
Job Summary
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.
KNOWLEDGE/SKILLS/ABILITIES
- Assesses 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 and eligibility for requested treatments and/or procedures.
- Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
- Processes requests within required timelines.
- Refers appropriate prior authorization requests to Medical Directors.
- 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 Care Model
- 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 State Plan.
- Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Registered Nurse (RN).
Required Experience
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $ $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
-
Care Review Clinician, Inpatient Review
3 weeks ago
Nebraska, United States Molina Healthcare Full timeJOB DESCRIPTIONJob SummaryMolina 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...
-
Care Review Clinician, Inpatient Review
1 month ago
Nebraska, United States Molina Healthcare Full timeJOB DESCRIPTIONJob SummaryMolina 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...
-
Telephonic Case Manager
2 months ago
Nebraska, United States Molina Healthcare Full timeJOB DESCRIPTIONOpportunity for a Nebraska licensed RN with a strong clinical background to join our health plan as a Case Manager. Preference is for candidates to have Case Management experience at a managed care organization. The position may require making infrequent face-to-face visits with our members, but most of the work will be done telephonically....
-
Telephonic Case Manager
3 weeks ago
Nebraska, United States Molina Healthcare Full timeJOB DESCRIPTIONOpportunity for a Nebraska licensed RN with a strong clinical background to join our health plan as a Case Manager. Preference is for candidates to have Case Management experience at a managed care organization. The position may require making infrequent face-to-face visits with our members, but most of the work will be done telephonically....
-
Remote Case Manager
5 days ago
Nebraska, United States Molina Healthcare Full timeJOB DESCRIPTIONOpportunity for a Nebraska licensed LMHP or LIMHP with a background in Behavioral Health to join our health plan as a Case Manager. The position may require making infrequent face-to-face visits with our members, but the majority of the work will be done telephonically. Schedule is Monday – Friday, 8 AM – 5PM CST and mileage is reimbursed...
-
Remote Case Manager
4 weeks ago
Nebraska, United States Molina Healthcare Full timeJOB DESCRIPTIONOpportunity for a Nebraska licensed LMHP or LIMHP with a background in Behavioral Health to join our health plan as a Case Manager. The position may require making infrequent face-to-face visits with our members, but the majority of the work will be done telephonically. Schedule is Monday – Friday, 8 AM – 5PM CST and mileage is reimbursed...
-
Remote Case Manager
3 weeks ago
Nebraska, United States Molina Healthcare Full timeJOB DESCRIPTIONOpportunity for a Nebraska licensed LMHP or LIMHP with a background in Behavioral Health to join our health plan as a Case Manager. The position may require making infrequent face-to-face visits with our members, but the majority of the work will be done telephonically. Schedule is Monday – Friday, 8 AM – 5PM CST and mileage is reimbursed...
-
Senior BASE24 Developer- REMOTE
5 days ago
Nebraska, United States First National Bank of Omaha Full timeAt FNBO, our employees are the heart of our story—and we're committed to their success Please see below the details of this career opportunity and how it fits into our organization's success.Our Modern, Flexible Workplace:We believe in a Modern, Flexible Workplace, and we are continuously exploring advancements in technology and office environments to make...
-
Senior BASE24 Developer- REMOTE
2 weeks ago
Nebraska, United States First National Bank of Omaha Full timeAt FNBO, our employees are the heart of our story—and we're committed to their success Please see below the details of this career opportunity and how it fits into our organization's success.Our Modern, Flexible Workplace:We believe in a Modern, Flexible Workplace, and we are continuously exploring advancements in technology and office environments to make...
-
Remote Special Education Teacher-Nebraska
6 days ago
Nebraska City, United States Soliant Full timeMinimum 1+ years special education experience required.Using virtual platforms and digital tools, you will deliver personalized instruction, develop individualized education plans (IEPs), and collaborate with students, families, and school teams to create inclusive learning experiences. Your work will focus on promoting equity, accessibility, and excellence...
-
Priority Care Physician Assistant
6 days ago
Nebraska, United States Commonspirit Health Full timeOverview Seeking PA to join our CHI Health Priority Care Team in the Omaha Metro area. CHI Health Priority Care is located in select locations across the system. We provide prompt, high-quality medical attention when your provider is not available. We offer same-day, unscheduled access to a primary care provider. Catholic Health Initiatives is a part of...
-
Tele-Neurology 100% REMOTE
2 months ago
Nebraska, United States Access TeleCare Full timeAccess TeleCare would love for you to consider joining our Telemedicine Neurology team! General and Sub-Specialty Neurologist welcome to apply! Whats in it for YOU? Our physicians experience less stress working from home. The proximity of being around their family is like no other. No more spending nights or weekends away from loved ones being at the...
-
Priority Care Physician Assistant
6 days ago
Nebraska, United States Commonspirit Health Full timeOverview Seeking PA to join our CHI Health Priority Care Team in the Omaha Metro area. CHI Health Priority Care is located in select locations across the system. We provide prompt, high-quality medical attention when your provider is not available. We offer same-day, unscheduled access to a primary care provider. Catholic Health Initiatives is a part of...
-
Dentist ( Remote/ Virtual)
3 weeks ago
Nebraska, United States Duvall Family Dental Full timeGeneral Dentist Opportunity in Duvall, Washington At Duvall Family Dental , we take pride in offering a unique dental experience that is tailor-made for the community we serve. As a distinguished member of the Heartland Dental supported offices, we stand committed to providing exceptional care with the full support of our dedicated practice manager, a...
-
Dentist ( Remote/ Virtual)
3 weeks ago
Nebraska, United States Duvall Family Dental Full timeGeneral Dentist Opportunity in Duvall, Washington At Duvall Family Dental , we take pride in offering a unique dental experience that is tailor-made for the community we serve. As a distinguished member of the Heartland Dental supported offices, we stand committed to providing exceptional care with the full support of our dedicated practice manager, a...
-
Nebraska, United States SonderMind Inc. Full timeSonderMind is a leading mental health care platform that is revolutionizing therapy services. We seek compassionate and highly skilled licensed mental health therapists to join our expanding network. As a SonderMind counselor, you will have the opportunity to make a meaningful impact on the lives of individuals seeking therapy while enjoying the flexibility...
-
Nebraska, United States SonderMind Inc. Full timeSonderMind is a leading mental health care platform that is revolutionizing therapy services. We seek compassionate and highly skilled licensed mental health therapists to join our expanding network. As a SonderMind counselor, you will have the opportunity to make a meaningful impact on the lives of individuals seeking therapy while enjoying the flexibility...
-
Dentist ( Remote/ Virtual)
3 weeks ago
Nebraska, United States Hillsboro Dental Center Full timeGeneral Dentist Opportunity in Hillsboro, Oregon At Hillsboro Dental Center , we take pride in offering a unique dental experience that is tailor-made for the community we serve. As a distinguished member of the Heartland Dental supported offices, we stand committed to providing exceptional care with the full support of our dedicated practice manager, a...
-
Dentist ( Remote/ Virtual)
3 weeks ago
Nebraska, United States Hillsboro Dental Center Full timeGeneral Dentist Opportunity in Hillsboro, Oregon At Hillsboro Dental Center , we take pride in offering a unique dental experience that is tailor-made for the community we serve. As a distinguished member of the Heartland Dental supported offices, we stand committed to providing exceptional care with the full support of our dedicated practice manager, a...
-
Client Operations Specialist
3 weeks ago
Nebraska, United States Optiv Full timeThis position can be hired remotely anywhere within the continental U.S.The Client Operations Specialist is a sales support role assisting field Client Managers with the development and closing of new business. Specialists complete the supporting functions related to outside sales such as generating price quotes, processing orders, assisting with client...