Care Review Clinician (LVN) Prior Auth – Must Live in TX

Fully remote opportunity for a TX licensed LVN with Utilization Management experience to join our Prior Authorization reviewing team. Previous UM experience with MCG/Interqual guidelines as reputed company as working reputed company UM in an MCO is highly preferred, but we will also consider UM experience reputed company a hospital as reputed company. Schedule is Monday – Friday, 9 AM – 6 PM CST. This position is with our Texas Health Plan, and these reviews will be for our reputed company Members in Texas. Reviews will include, but are not limited to, doctor appointments, outpatient services, DME. Solid experience with reputed company Office Suite is necessary, especially with reputed company, reputed company, Teams, and One Note. Job reputed company Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and reputed company with established clinical guidelines, insurance policies, and regulations - ensuring members reputed company desired reputed company through integrated delivery of care across the continuum. Contributes to overarching reputed company to reputed company reputed company and cost-effective member care. Essential Job Duties • Assesses services for members to ensure reputed company reputed company, cost-effectiveness and compliance with reputed company 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 reputed company required timelines. • Refers appropriate cases to medical directors (MDs) and presents cases 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 health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state reputed company licensing mandates. If licensed, license must be reputed company and unrestricted in state of reputed company. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. •reputed company Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified reputed company in reputed company Management (CPHM). • Recent hospital experience in a medical unit or emergency room. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Job Info • Job Identification2033975 • Job CategoryClinical • Posting Date29/10/2025, 08:10 • Job ScheduleFull time • Locations 200 Oceangate, Long Beach, CA, 90802, US Apply tot his job Apply To this Job