Long Beach, California, United States · Remote OK
$23/hr–$51/hr
JOB DESCRIPTION This RN will act as a Care Review Clinician supporting our Medicare members who have recently been admitted to this hospital. The Medicare will support them to ensure a successful transition from inpatien…
Skills: Case Management, Managed Care, Inpatient Review, Prior Authorization, Clinical Assessment
Long Beach, California, United States · On-site
$45k–$89k/yr
JOB DESCRIPTION Job Summary Provides senior level support for government contracts activities. Responsible for the development and administration of contracts with state and/or federal governments for Medicaid, Medicare,…
Skills: Government Contracts Administration, Regulatory Compliance, Medicaid, Medicare, Marketplace Programs
Long Beach, California, United States · On-site
Job Summary Provides subject matter expertise and leadership for health plan provider network complex contracting activities. Supports network strategy and development with respect to adequacy, financial performance and …
Skills: Provider Network Contracting, Value-Based Payment Methodology, Contract Negotiation, Managed Care, Financial Analysis
Long Beach, California, United States · On-site
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Skills: Competitive Intelligence, Market Analysis, RFP Management, Strategic Planning, Cross-functional Collaboration
Long Beach, California, United States · On-site
$49k–$107k/yr
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Skills: Data Analysis, SQL, Excel, Business Intelligence Tools, Healthcare Analytics
Long Beach, California, United States · On-site
$23/hr–$30/hr
At WelbeHealth, each participant of our program is guided by our interdisciplinary team (IDT) - composed of clinical and non-clinical members who work cohesively to provide quality patient-centered care. Our values and p…
Skills: Administrative Support, Scheduling, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
Huntington Beach, California, United States · On-site
$121k–$181k/yr
At Bayer we’re visionaries, driven to solve the world’s toughest challenges and striving for a world where 'Health for all Hunger for none’ is no longer a dream, but a real possibility. We’re doing it with energy, curios…
Skills: Pharmaceutical Sales, Relationship Management, Clinical Education, Strategic Business Planning, Cardiovascular Knowledge
Long Beach, California, United States · On-site
JOB DESCRIPTION Job Summary Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in ac…
Skills: Claims Processing, Customer Service, Provider Service, Time Management, Verbal Communication
Long Beach, California, United States · On-site
JOB DESCRIPTION Job Summary Provides lead level analyst support for configuration information management activities. Responsible for accurate and timely implementation and maintenance of critical information on claims da…
Skills: Configuration Information Management, Networx Pricer, QNXT, Claims Processing, Data Analysis
Long Beach, California, United States · On-site
$20/hr–$40/hr
JOB DESCRIPTION Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases. Sync…
Skills: Provider Configuration, Data Validation, Claims Processing, Critical Thinking, Attention To Detail
Long Beach, California, United States · On-site
$60k–$130k/yr
JOB DESCRIPTION Job Summary Provides senior level analyst support for advanced provider data management (PDM) activities including analyzing business processes related to PDM, identifying areas for improvement, and devel…
Skills: Business Analysis, SQL, Data Analysis, BRD Creation, FRD Creation
Long Beach, California, United States · Remote OK
JOB DESCRIPTION Job Summary Leads and supervises team responsible for payment integrity activities including recovery operations. Responsible for performance, quality levels and establishing procedures and techniques tha…
Skills: Payment Integrity, Recovery Operations, Claims Processing, Inventory Management, Quality Control
Long Beach, California, United States · Remote OK
JOB DESCRIPTION Job Summary Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, …
Skills: Project Management, Scrum Master, Process Improvement, Organizational Change Management, Risk Management
Long Beach, California, United States · Remote OK
$83k–$164k/yr
***Remote and must live in Washington*** JOB DESCRIPTION Job Summary Provides subject matter expertise and leadership for health plan provider network complex contracting activities. Supports network strategy and develop…
Skills: Contract Negotiation, Value-Based Payment Methodology, Provider Relationship Management, Financial Analysis, Network Adequacy
Long Beach, California, United States · Remote Solely
JOB DESCRIPTION Job SummaryProvides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overar…
Skills: Medical Coding, ICD-10, CPT Codes, Risk Adjustment, Chart Reviews
Long Beach, California, United States · Remote OK
$66k–$143k/yr
JOB DESCRIPTION Job Summary The Lead Analyst serves as a data steward with deep subject matter expertise, responsible for designing and prototyping Medical Economics data assets that are clearly defined and fit for use. …
Skills: SQL, Data Stewardship, Healthcare Analytics, Medical Economics, Data Modeling
Long Beach, California, United States · Hybrid
$20/hr–$28/hr
Join Cortica as a School Behavior Technician Empower students. Support families. Advance the standard of neurodevelopmental care. Cortica is seeking a dedicated and compassionate School Behavior Technician (SBT) to provi…
Skills: ABA Therapy, Behavior Intervention Plans, Data Collection, De-escalation, Crisis Protocols
Long Beach, California, United States · On-site
JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the co…
Skills: Administrative Support, Case Management, Data Entry, Customer Service, Time Management
Long Beach, California, United States · On-site
JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to …
Skills: Care Management, Care Coordination, Comprehensive Assessments, Motivational Interviewing, Medication Reconciliation
Long Beach, California, United States · On-site
$23/hr–$37/hr
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate…
Skills: Leadership, Supervision, Inventory Management, Financial Management, Customer Service
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The clinician assesses Medicare members to ensure medically necessary services and a successful transition from inpatient care to home or nursing facilities. They analyze clinical service requests against evidence-based guidelines and collaborate with multidisciplinary teams to optimize member outcomes.
Requires a Registered Nurse (RN) license and at least 2 years of experience in acute care, inpatient review, or managed care. Proficiency in Microsoft Office and strong organizational and communication skills are essential.
JOB DESCRIPTION
This RN will act as a Care Review Clinician supporting our Medicare members who have recently been admitted to this hospital. The Medicare will support them to ensure a successful transition from inpatient to discharge to either a nursing facility or back to their home. The position is a combination of phone call outreach and in person meetings with the members while still inpatient. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes.
This is a remote position and productivity is important. Preferred candidates will have previous case management, managed care, or inpatient hospital experience. Experience in a behavioral health setting would be a plus.
Schedule: Monday through Friday 7:00AM to 5:00PM EST Flexible work schedule (Weekends, holidays, no night, no call.) Alternative work schedule ava immediately exp: 8–10-hour shifts w/ 1-2 weekend days (Saturday or Sunday)
Provides support for clinical member services review assessment processes. 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.
Essential Job Duties
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all 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 within required timelines.
• Refers appropriate cases to medical directors (MDs) and presents them 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 experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
• Certified Professional in Healthcare Management (CPHM).
• Recent hospital experience in an intensive care unit (ICU) or emergency room.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care. Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.
Offices: 200 Oceangate, Long Beach, California 90802, US
There are currently 801 open healthcare positions in Long Beach, CA listed on Clera. New openings are added daily as companies post roles.
Companies currently hiring include Molina Healthcare, SCAN, TruCare Community, St. Mary Medical Center, CVS Health, among others. Browse the listings above to see every active employer.
Yes — 237 of the 801 open healthcare positions offer remote or hybrid work (132 remote, 105 hybrid).
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