# Care Review Clinician (RN) at Molina Healthcare

> Open job at Molina Healthcare. Workplace: On-site.

Source: Nurse Jobs World, https://nursejobsworld.com/jobs/molina-healthcare-care-review-clinician-rn-slpp3zo
Posted 3 November 2026. Last checked on the employer's career site: 4 November 2026.

## Facts

- Company: [Molina Healthcare](https://nursejobsworld.com/companies/molina-healthcare)
- Location: On-site
- Workplace: On-site
- Employment type: Full-time
- Local language: Not required
- Not mentioned in the job post: salary, visa sponsorship, relocation, where you can apply from

## 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).
• Recent hospital experience in an intensive care unit (ICU) or emergency room.

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

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

## How to apply

Apply on the job page, https://nursejobsworld.com/jobs/molina-healthcare-care-review-clinician-rn-slpp3zo: its Apply button opens the employer's own application page.

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