Inpatient Review Registered Nurse in Spartanburg, SC

Job Summary: We are looking for an experienced Registered Nurse (RN) to join our team as an Inpatient Review Clinician. In this role, you will provide prior authorization for outpatient and inpatient services within the behavioral health population. You should have a strong background in post-acute care settings and be adept at multi-tasking in a fast-paced environment. Key Responsibilities: • Assess services for members to ensure optimal outcomes, cost-effectiveness, and compliance with all relevant regulations and guidelines. • Analyze clinical service requests against established evidence-based clinical guidelines. • Identify appropriate benefits, eligibility, and expected lengths of stay for requested treatments and procedures. • Conduct reviews to determine prior authorization and financial responsibility for Molina and its members. • Process requests within required timelines and refer complex cases to medical directors. • Request additional information from members or providers as needed. • Collaborate with multidisciplinary teams to enhance the Molina care model. • Adhere to utilization management policies and procedures. Work Schedule: Monday to Friday, 8:00 AM to 5:00 PM EST, with a need for weekend availability (Saturday or Sunday). This is a remote position; a high-speed internet connection is required. Required Qualifications: • A minimum of 2 years of experience in hospital acute care, inpatient review, prior authorization, or managed care. • Active Registered Nurse (RN) license in the practice state. • Excellent prioritization and organizational skills. • Strong problem-solving, critical-thinking abilities, and communication skills. • Proficiency in Microsoft Office and relevant software. Preferred Qualifications: • Certification as a Professional in Healthcare Management (CPHM). • Recent experience in an Intensive Care Unit (ICU) or Emergency Room. Molina Healthcare provides a competitive compensation package and is proud to be an Equal Opportunity Employer. Pay Range: $26.41 - $61.79 per hour (actual compensation may vary based on experience and skills).