[Skip to main content](#main-content) [ OpenNash ](https://opennash.com/) / [Jobs](https://jobs.opennash.com/) [ 01 Search jobs](https://jobs.opennash.com/search/)[ 02 Companies](https://jobs.opennash.com/explore/)[ 03 Hiring report](https://jobs.opennash.com/reports/hiring/)[ 04 AI assistants](https://jobs.opennash.com/connect/)[ 05 How it works](https://jobs.opennash.com/methodology/) Molina Healthcare · Waltham, MA # RN Care Review Clinician Waltham, MA, United States Listed on Molina Healthcare’s official careers site. Posted October 20, 2026. Check that it is still open and apply there. [Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039721) [OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / RN Care Review Clinician ## Job description ### JOB DESCRIPTION Job SummaryProvides 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 ## At a glance - Posted by the employer: Oct 20, 2026 - First seen by OpenNash: Oct 25, 2026 - Last checked: Nov 8, 2026 - Listed for: 19 days - Location: Waltham, MA, United States[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039721) ## Hiring at Molina Healthcare - Open jobs: 455 - New in the last 7 days: After two weekly collections - Tracked since: Jul 10, 2026 [All Molina Healthcare jobs](https://jobs.opennash.com/companies/molina-healthcare/) · [Weekly hiring report](/reports/hiring/) ## More jobs at Molina Healthcare ### [Lead, Healthcare Services](https://jobs.opennash.com/companies/molina-healthcare/jobs/b5905492185ab06d76c2/) Waltham, MA, United States ### [Care Manager, LTSS - Polk / Dubuque Counties](https://jobs.opennash.com/companies/molina-healthcare/jobs/034d0bdea572b9ab6a41/) Des Moines, IA, United States ### [Care Review Clinician, Applied Behavioral Analysis (ABA)](https://jobs.opennash.com/companies/molina-healthcare/jobs/db6392055f4082099f51/) United States ### [Community Connector (In Field Travel) - Southern NM ONLY](https://jobs.opennash.com/companies/molina-healthcare/jobs/8d7ec621d4713bdfb2eb/) Las Cruces, NM, United States ### [Health Plan Provider Contracts Manager (Contract Experience Required)](https://jobs.opennash.com/companies/molina-healthcare/jobs/20211cedf0993856aeb1/) Ridgeland, MS, United States ## Similar jobs at other companies ### [Utilization Review Clinician - Behavioral Health](https://jobs.opennash.com/companies/centene/jobs/e94515b02e95c057202c/) Centene · Remote-GA ### [Utilization & Review Clinician (MSW)](https://jobs.opennash.com/companies/universal-health-services/jobs/5af9905fde45830e371e/) Universal Health Services · SACRAMENTO, California ### [Licensed Behavioral Health Clinician - LCSW, LPC or LMFT](https://jobs.opennash.com/companies/unitedhealth-group/jobs/b0610c8d97ebcefd4dc2/) UnitedHealth Group · Bristol, Connecticut ### [Senior Clinician Recruiter - Remote in New England](https://jobs.opennash.com/companies/unitedhealth-group/jobs/b377a5f05dc1cabf3d0e/) UnitedHealth Group · Boston, Massachusetts ### [Licensed Independent Behavioral Health Clinician Case Manager](https://jobs.opennash.com/companies/cvs-health/jobs/e44ddf1a2519c1809b5d/) CVS Health · Work At Home-Pennsylvania [Jobs in Waltham, MA](/locations/us/ma/waltham/)[Jobs in Massachusetts](/locations/us-ma/) OpenNash lists jobs from employers’ own careers sites and does not handle applications. Dates come from the employer where stated; “first seen” and “last checked” are our own observations. [ OpenNash ](https://opennash.com/) AI-native services firm that builds custom software and 24/7 AI agents. OpenNash Jobs is an OpenNash Applied AI project. [Book time with OpenNash](https://calendly.com/opennash/new-meeting?hide_gdpr_banner=1) Jobs - [Search jobs](https://jobs.opennash.com/search/) - [Companies](https://jobs.opennash.com/explore/) - [Hiring report](https://jobs.opennash.com/reports/hiring/) - [AI assistants](https://jobs.opennash.com/connect/) - [How it works](https://jobs.opennash.com/methodology/) OpenNash - [opennash.com](https://opennash.com/) - [Services](https://opennash.com/ai-agent-consulting/) - [OpenNash CX](https://opennash.com/cx/) - [AI Tools](https://opennash.com/ai-tools/) - [Blog](https://opennash.com/blog/) - [About](https://opennash.com/about/) Contact - [hello@opennash.com](mailto:hello@opennash.com) - [LinkedIn](https://www.linkedin.com/company/opennash) - [Support](https://jobs.opennash.com/support/) - [Privacy](https://jobs.opennash.com/privacy/) - [Terms](https://jobs.opennash.com/terms/) © 2026 OpenNash, Inc. Company names and public job postings belong to their respective owners. Employers control source availability and application decisions.