Long Beach, California, United States · Remote OK
$23/hr–$51/hr
JOB DESCRIPTION This RN will act as a Care Review Clinician supporting our Medicaid members who have recently been admitted to this hospital. The Medicaid will support them to ensure a successful transition from inpatien…
Skills: Case Management, Managed Care, Utilization Management, Clinical Review, Prior Authorization
Long Beach, California, United States · On-site
$33/hr–$51/hr
Company Description Long Beach BMW/MINI, a Sonic Automotive dealership, is one of the fastest-growing brands within the automotive industry. We are building a business based on doing things the right way. From the way we…
Skills: Vehicle Diagnosis, Automotive Repair, BMW Technical Expertise, Road-testing, Hazardous Waste Disposal
Long Beach, California, United States · Hybrid
$23/hr–$51/hr
JOB DESCRIPTION This RN will act as a Care Manager supporting our Medicaid, Medicare and Marketplace members who have recently been admitted to this hospital. The Medicaid will support them to ensure a successful transit…
Skills: Care Management, Case Management, Patient Assessment, Care Coordination, Motivational Interviewing
Long Beach, California, United States · On-site
JOB DESCRIPTION Job Summary Provides administrative support for Wisconsin IRIS program operations, including referrals, enrollment, eligibility, service authorization and other administrative related requirements of the …
Skills: Administrative Support, Customer Service, Data Entry, Analytical Skills, Problem Solving
Long Beach, California, United States · On-site
$36/hr–$37/hr
RelaDyne is the nation’s leading automotive, industrial, and commercial lubricants provider and a trusted partner for reliability services. We’re more than just a distributor; we’re a team dedicated to innovation, servic…
Skills: Diesel Engine Repair, Preventive Maintenance, Electrical Systems Diagnosis, Air Brake Systems, Hydraulic Systems
Long Beach, California, United States · On-site
$18/hr–$25/hr
Company Overview Neill Aircraft Company is a family owned and operated business based in Long Beach, California since 1956. Specializing in "Build-to-Print" services, we work with materials Aluminum, Titanium, Inconel, a…
Skills: Sheet Metal Fabrication, Blueprint Reading, Precision Measuring, Drilling, Trimming
Long Beach, California, United States · On-site
$14/hr–$26/hr
JOB DESCRIPTION Job Summary Must reside in Florida. Provides support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, …
Skills: Claims Examination, Claims Adjudication, Medical Coding, Fraud Detection, Data Entry
Long Beach, California, United States · On-site
$164k–$246k/yr
At Relativity Space, we’re building rockets to serve today’s needs and tomorrow’s breakthroughs. Our Terran R vehicle will deliver customer payloads to orbit, meeting the growing demand for launch capacity. But that’s ju…
Skills: Systems Integration, Test Campaign Management, Requirements Decomposition, Risk Adjudication, Mechanical Engineering
Long Beach, California, United States · On-site
JOB DESCRIPTION Job SummaryProvides support for community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vu…
Skills: Member Advocacy, Community Outreach, Case Management, 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 · Hybrid
We are seeking a highly skilled and experienced Embedded Controls Software Engineer to join our team. The ideal candidate will have a strong background in embedded development supporting complex, distributed, safety crit…
Skills: Embedded C, RTOS, MISRA C, CAN, LIN
Long Beach, California, United States · Remote OK
$49k–$107k/yr
JOB DESCRIPTION Job Summary Provides senior level support for clinical quality member intervention activities. Responsible for the developing and implementing new and existing member intervention initiatives including al…
Skills: Data Analysis, HEDIS, NCQA, Business Writing, Problem Solving
Long Beach, California, United States · Remote OK
$26/hr–$56/hr
Job Description Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines…
Skills: Medical Review, Utilization Review, Medical Necessity, ICD-10, CPT Coding
Long Beach, California, United States · Remote OK
$49k–$107k/yr
JOB DESCRIPTION Job Summary Provides senior level support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes Uses a consultative approa…
Skills: Provider Engagement, Risk Adjustment, HEDIS Quality Scores, Value-Based Care, Data Analysis
Long Beach, California, United States · Remote OK
$66k–$143k/yr
JOB DESCRIPTION Job Summary Leads and manages team responsible for health plan provider engagement activities. Collaborates with senior leadership and the health plan network team to drive value-based care strategies, an…
Skills: Provider Engagement, Value-Based Care, Risk Adjustment, Quality Improvement, HEDIS/NCQA
Long Beach, California, United States · Remote OK
$49k–$107k/yr
JOB DESCRIPTION Job Summary Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databa…
Skills: Provider Configuration, Data Validation, Auditing, Compliance Reporting, Microsoft Excel
Long Beach, California, United States · On-site
$22/hr–$26/hr
CAREER COACH A Day in the Life: The Career Coach works to develop pathways toward employment and self-sufficiency for students by building their vocational abilities and confidence. The Career Coach is an onsite part-tim…
Skills: Career Coaching, Vocational Training, Case Management, Interview Preparation, Job Search Assistance
Long Beach, California, United States · On-site
$20/hr–$24/hr
Become an Activity Director for Villa Redondo! Tues-Sat (9am-5:30pm) $500 Sign On Bonus Villa Redondo is a assisted living facility for the elderly community (ages 59+) located in Downtown Long Beach, CA. We are currentl…
Skills: Activity Planning, Program Development, Resident Relations, Volunteer Management, Event Coordination
Long Beach, California, United States · On-site
$20/hr–$25/hr
Become a Maintenance Technician for Villa Redondo Care! $500 Sign On Bonus (9am-5pm, Mon-Fri, Full-Time) Villa Redondo Care is an assisted living facility for the elderly community (ages 59+) located in Long Beach, CA. W…
Skills: General Maintenance, Janitorial Tasks, Contractor Management, Preventative Maintenance, Inventory Management
Long Beach, California, United States · On-site
$19/hr–$21/hr
Become an Assistant Cook for Breeze Care! ($500 Sign On Bonus) Bay Breeze Care is an assisted living facility for the adult community ages (18-59) located in Long Beach, CA. We are currently looking for a dedicated, moti…
Skills: Food Preparation, Dietary Management, Food Safety, Kitchen Maintenance, Portion Control
Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
The clinician conducts clinical reviews and assessments for Medicaid members to ensure medical necessity and successful transitions from inpatient care. They collaborate with multidisciplinary teams to provide cost-effective care and adhere to utilization management policies.
Requires a Registered Nurse (RN) license with at least 2 years of experience in acute care, inpatient review, or managed care. Proficiency in Microsoft Office and strong organizational skills are essential.
JOB DESCRIPTION
This RN will act as a Care Review Clinician supporting our Medicaid members who have recently been admitted to this hospital. The Medicaid 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 telephonic 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 7:00PM EST Flexible PST 8 hours (No weekends, no nights, no holidays, no call.)
Job Summary
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 a plus, 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
