Registered Nurse Case Manager - Inpatient Review (NIGHT SHIFT)

Join Our Team of Compassionate Healthcare Professionals! We are seeking a skilled and dedicated Registered Nurse Case Manager to join our Inpatient Review team, working a permanent 12-hour night shift (7:30 PM - 8:30 AM Pacific Time) on a 3-day per week rotating schedule, including weekends and holidays. As a key member of our team, you will play a vital role in assessing, facilitating, planning, and coordinating integrated care for our members with high-need potential.

This position offers a hybrid work model, combining remote work with time in our office, and a competitive salary range of $23.76 - $51.49 per hour. If you have a passion for delivering high-quality patient care and a strong background in utilization management, we encourage you to apply.

Job Summary: As a Registered Nurse Case Manager, you will work collaboratively with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate care across the continuum, ensuring that patients receive medically appropriate and cost-effective care. Your expertise will help drive optimal outcomes, cost-effectiveness, and compliance with state and federal regulations.

Key Responsibilities:

• Assess inpatient services to ensure optimum outcomes, cost-effectiveness, and compliance with regulations
• Analyze clinical service requests against evidence-based guidelines
• Conduct inpatient reviews to determine financial responsibility and perform prior authorization reviews as needed
• Process requests within required timelines and refer cases to Medical Directors as necessary
• Collaborate with multidisciplinary teams to promote the Molina Care Model and adhere to UM policies and procedures

Requirements:

• Graduate from an Accredited School of Nursing
• 3+ years of hospital acute care/medical experience
• Active, unrestricted State Registered Nursing (RN) license in good standing (California RN licensure required)
• Valid driver's license with a good driving record (if applicable)

Preferred Qualifications:

• Bachelor's Degree in Nursing
• Recent hospital experience in ICU, Medical, or ER unit
• Active, unrestricted Utilization Management Certification (CPHM)

What We Offer: Molina Healthcare provides a competitive benefits and compensation package, opportunities for professional growth and development, and a collaborative work environment. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Apply Now and join our team of dedicated healthcare professionals!

Join Our Team!

This is a fantastic opportunity to grow your career with a leading healthcare organization. If you have the skills and passion we're looking for, please submit your application today.