Care Review Clinician - Resident of NM or TX - Compact license
MolinaSanta Fe, New Mexico, United States • Las Cruces, New Mexico, United States • Albuquerque, New Mexico, United States • Rio Rancho, New Mexico, United States • Roswell, New Mexico, United States • Rio Rancho, New Mexico, United States • Anchorage, Alaska, United States • Hollister, California, United States • Chandler, Arizona, United States • Texas, United States
Posted September 25, 2025
Full Time
About the Company
Molina Healthcare is a FORTUNE 500 company specializing in government-sponsored health care programs. They contract with state governments to provide managed care services across multiple states, including Medicaid and Medicare plans. Molina's focus on quality health care services for eligible families and individuals sets them apart in the industry.
Job Description
Molina Healthcare Services is seeking experienced Utilization Review RNs or LPNs with a compact license to review prior authorization requests for members of New Mexico and Texas Medicaid recipients. The role involves assessing service needs, analyzing clinical requests, and ensuring compliance with regulations. This position focuses on promoting quality care, cost effectiveness, and behavioral health and long-term care. Productivity and timely turnaround times are essential.
Requirements
- Assesses services for members.
- Analyzes clinical service requests.
- Processes requests within required timelines.
- Verifies financial responsibility for Molina.
- Collaborates with multidisciplinary teams.
- Adheres to UM policies and procedures.