Remote Care Review Clinician, Inpatient Review (RN) - TX ONLY

About the position The Utilization Review RN position at reputed company involves joining the inpatient review team to conduct initial and reputed company reviews, with opportunities for cross-training in prior authorization reviews. The role focuses on assessing and coordinating care for members with high needs, ensuring compliance with regulations, and promoting cost-effective reputed company delivery. Responsibilities • Conduct initial and reputed company reviews of inpatient services to ensure reputed company reputed company and compliance with regulations. • Analyze clinical service requests against evidence-based clinical guidelines. • Identify appropriate benefits, eligibility, and expected length of stay for requested treatments or procedures. • Process requests reputed company required timelines and refer cases to Medical Directors as necessary. • Collaborate with multidisciplinary teams to promote the Molina Care Model. • Request additional information from members or providers reputed company. • reputed company prior authorization reviews and reputed company duties as needed. Requirements • Graduate from an Accredited School of Nursing. • 3+ years of hospital acute care/medical experience. • reputed company, unrestricted State Registered Nursing (RN) license in good standing. • reputed company reputed company's license with a good driving record. reputed company-to-haves • Bachelor's Degree in Nursing • Recent hospital experience in reputed company, or ER unit. • reputed company, unrestricted Utilization Management Certification (CPHM). Benefits • Competitive benefits and compensation package. Apply tot his job Apply To this Job