Care Review Clinician (RN)
MolinaCleveland, Ohio, United States • Akron, Ohio, United States • Dayton, Ohio, United States • Cincinnati, Ohio, United States • Columbus, Ohio, United States
Posted October 23, 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
The Care Review Clinician (RN) supports clinical member services review and assessment processes. This role verifies medical necessity, aligns with clinical guidelines, and contributes to quality and cost-effective member care. The role involves reviewing requests for benefits, eligibility, and authorization. They also collaborate with multidisciplinary teams and adhere to utilization management policies.
Requirements
- At least 2 years experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent.
- Registered Nurse (RN) license active and unrestricted in state of practice.
Benefits
- Competitive benefits package