Experienced RN Inpatient Review Case Manager for California - Remote Opportunity with Competitive Salary and Benefits

Introduction to Molina Healthcare Services

Molina Healthcare Services (HCS) is a leading healthcare organization dedicated to providing high-quality, patient-centered care to its members. We work tirelessly to ensure that our patients receive the best possible outcomes, with a focus on cost-effective and medically appropriate care. Our team of skilled professionals, including nurses, providers, and multidisciplinary team members, collaborate to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum. If you're a motivated and results-driven RN looking for a new challenge, we invite you to join our team as an Inpatient Review Case Manager for California.

Job Summary

As an RN Inpatient Review Case Manager, you will play a critical role in assessing inpatient services for our members, ensuring optimum outcomes, cost-effectiveness, and compliance with all state and federal regulations and guidelines. You will analyze clinical service requests, identify appropriate benefits and eligibility, and conduct inpatient reviews to determine financial responsibility for Molina Healthcare and its members. This is a remote opportunity, allowing you to work from the comfort of your own home, with a competitive salary and benefits package.

Key Responsibilities

• Assess inpatient services for members to ensure optimum outcomes, cost-effectiveness, and compliance with all state and federal regulations and guidelines
• Analyze clinical service requests from members or providers against evidence-based clinical guidelines
• Identify appropriate benefits, eligibility, and expected length of stay for requested treatments and/or procedures
• Conduct inpatient reviews to determine financial responsibility for Molina Healthcare and its members
• Process requests within required timelines and refer appropriate cases to Medical Directors
• Collaborate with multidisciplinary teams to promote the Molina Care Model and adhere to UM policies and procedures
• Make appropriate referrals to other clinical programs and request additional information from members or providers as needed

Essential Qualifications

To be successful in this role, you will need:

• Graduate from an Accredited School of Nursing
• 3+ years of hospital acute care/medical experience
• Prior experience in Managed care using Interqual or MCG guidelines
• An active, unrestricted State Registered Nursing (RN) license in good standing, specifically a California license

Preferred Qualifications

While not required, the following qualifications are preferred:

• Bachelor's Degree in Nursing
• Recent hospital experience in ICU, Medical, or ER unit
• Active, unrestricted Utilization Management Certification (CPHM)

Skills and Competencies

To excel in this role, you will need:

• Excellent computer multi-tasking skills and analytical thought process
• Strong communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong attention to detail and organizational skills
• Ability to work in a fast-paced environment and meet deadlines

Career Growth Opportunities and Learning Benefits

At Molina Healthcare, we are committed to the growth and development of our employees. As an RN Inpatient Review Case Manager, you will have access to:

• Ongoing training and education opportunities
• Professional development and career advancement opportunities
• A collaborative and supportive work environment
• Recognition and reward for outstanding performance

Work Environment and Company Culture

Our company culture is built on a foundation of excellence, integrity, and respect. We value diversity and inclusion, and we are committed to creating a work environment that is welcoming and supportive to all employees. As a remote employee, you will be part of a virtual team, with regular communication and collaboration with your colleagues.

Compensation, Perks, and Benefits

We offer a competitive compensation package, including:

• A salary range of $23.76 - $51.49 per hour
• Comprehensive benefits package, including medical, dental, and vision coverage
• 401(k) retirement plan with company match
• Paid time off and holidays
• Opportunities for professional development and career advancement

Conclusion

If you are a motivated and results-driven RN looking for a new challenge, we invite you to join our team as an Inpatient Review Case Manager for California. This is a remote opportunity, allowing you to work from the comfort of your own home, with a competitive salary and benefits package. Apply now to take the first step in your new career!

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