Long Beach, California, United States · Remote Solely
JOB DESCRIPTION **Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday through Friday from 8:30 AM to 5:30 PM CST and requires prior experience in Utilization Management (UM) an…
Skills: Utilization Management, MCG Guidelines, Clinical Review, Medical Necessity Assessment, Prior Authorization
Long Beach, California, United States · On-site
$18/hr–$26/hr
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Long Beach, California, United States · Remote OK
$14/hr–$29/hr
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Long Beach, California, United States · On-site
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Long Beach, California, United States · On-site
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Skills: Mechanical Design, Heat Transfer, Fluids, Structural Mechanics, Finite Element Analysis
Long Beach, California, United States · On-site
$100k–$151k/yr
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Skills: Fluid Dynamics, Thermodynamics, Cryogenic Systems, Mechanical Design, Rocket Engine Development
Long Beach, California, United States · On-site
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Skills: Carpentry, Plumbing, Electrical Maintenance, HVAC Repair, Painting
Long Beach, California, United States · Hybrid
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Space is a warfighting domain. True Anomaly seeks those with the talent and ambition to build the technology that secures it. OUR MISSION True Anomaly delivers decisive capabilities for space superiority. We build autono…
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Long Beach, California, United States · Hybrid
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As a CNC Programmer/Operator, you will be responsible for programming, setting up, and operating CNC milling machines and 5-axis gantry mills (DMG MORI and Fooke) to produce high-quality parts and components for prototyp…
Skills: CNC Programming, CNC Operation, CAM Software, 5-Axis Gantry Milling, Blueprint Interpretation
Long Beach, California, United States · Hybrid
$95k–$159k/yr
As a CNC Programmer/Operator, you will be responsible for programming, setting up, and operating CNC milling machines and 5-axis gantry mills (DMG MORI and Fooke) to produce high-quality parts and components for prototyp…
Skills: CNC Programming, CNC Operation, CAM Software, G-code, 5-Axis Milling
Long Beach, California, United States · On-site
JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. Collaborates with multidisciplinary team coordinating integrated delivery of …
Skills: Care Management, Care Coordination, Member Assessment, Care Planning, Waiver Enrollment
Long Beach, California, United States · Remote OK
$14/hr–$29/hr
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 Assignment, Member Screening, Data Entry, Scheduling
Long Beach, California, United States · On-site
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At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to our most vulnerable senior population by serving as both a care provider and care plan to the participants…
Skills: Customer Service, Scheduling, Salesforce, MS Office Suite, Athena
Long Beach, California, United States · On-site
Where You’ll Work Founded in 1923, Dignity Health - St. Mary Medical Center is a 389-bed, acute care, nonprofit hospital located in Long Beach, California. Serving over 80,000 patients annually, the hospital offers a ful…
Skills: Patient Assessment, Critical Thinking, Labor & Delivery Care, Patient Care Planning, Interdisciplinary Collaboration
Long Beach, California, United States · On-site
$18/hr–$20/hr
Continental Battery Systems is a rapidly growing North American PE-backed company looking to add a highly-skilled, energetic, and collaborative employee to our team. We are seeking a career-minded candidate looking for a…
Skills: Safe Driving, Warehouse Operations, Customer Service, Route Planning, Inventory Management
Long Beach, California, United States · On-site
$20/hr–$25/hr
Description Location: Live Onsite at 1625 Redondo Ave, Long Beach, CA 90804 Pay: $20.00–$25.00/hour + $150 Monthly Auto Allowance Housing: 2 Bed / 2 Bath Apartment Included (Employee Rent: $677/month) Schedule: Full-Time…
Skills: Property Management, Resident Relations, Leasing, Collections, Vendor Coordination
Long Beach, California, United States · On-site
Job Description You've been working your way up in the restaurant world for awhile. Maybe you even have a little college under your belt on the subject. Whatever the case may be, you know you want to manage a restaurant.…
Skills: Restaurant Management, Inventory Management, Cash Handling, Profit Management, Sales Management
Long Beach, California, United States · On-site
$25/hr–$30/hr
We're Hiring: Support Specialist| Event Staff (Warehouse & Event Production) Are you someone who enjoys staying active, working with your hands, and being part of exciting live events? We're looking for a Full-Time Suppo…
Skills: Event Production, Warehouse Management, Equipment Maintenance, Loading And Unloading, Assembly
Long Beach, California, United States · On-site
$34/hr–$38/hr
Job Title: Leasing Manager Salary: $34 to $38 per hour Unlock your potential with Avenue5 Residential. Your ideas. Your development. Your experience. We take care of you, so you can take care of our residents, properties…
Skills: Leasing Management, Customer Service, Interpersonal Communication, Microsoft Office Suite, Time Management
Long Beach, California, United States · On-site
Overview Company Overview: Allied Universal®, North America’s leading security and facility services company, offers rewarding careers that provide you a sense of purpose. While working in a dynamic, welcoming, and colla…
Skills: Security patrols, Incident reporting, Emergency response, Conflict mediation, Communication
Long Beach, California, United States • Remote Solely
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Responsible for performing utilization reviews and clinical determinations to ensure services are medically necessary and cost-effective. Collaborates with multidisciplinary teams to manage member care and ensure compliance with state and federal regulations.
Requires a Registered Nurse (RN) license active in Illinois and at least 2 years of experience in acute care, inpatient review, or managed care. Proficiency in MCG guidelines and utilization management is essential.
JOB DESCRIPTION
Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday through Friday from 8:30 AM to 5:30 PM CST and requires prior experience in Utilization Management (UM) and the application of MCG guidelines. Candidates should be comfortable performing utilization reviews and making clinical determinations based on established criteria.
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, 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
