Care Review Clinician LPN / LVN

Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. 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 board licensing mandates. Microsoft Office suite/applicable software program(s) proficiency. LPN / LVN licensure required Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays. Training will be held Mon - Fri Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V 17 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-10-06