[Skip to main content](#main-content) [OpenNash Jobs](https://jobs.opennash.com/) [Hiring report](/reports/hiring/) · [All Molina Healthcare jobs](https://jobs.opennash.com/companies/molina-healthcare/) · [Search jobs](/search/) Molina Healthcare · United States # Care Review Clinician (RN) United States Full-time Healthcare & Clinical Listed on Molina Healthcare’s official careers site. Posted October 29, 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/2039588) [OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / Care Review Clinician (RN) ## Job description ### 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 - Position supports the central time zone. - IL license is preferred but can be obtained upon hire. ### 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 29, 2026 - First seen by OpenNash: Nov 1, 2026 - Last checked: Nov 1, 2026 - Listed for: 3 days - Location: United States - Employment type: Full-time[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039588) ## Hiring at Molina Healthcare - Open jobs: 439 - 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 ### [Analyst, Pre-Pay Dispute Coding (Remote)](https://jobs.opennash.com/companies/molina-healthcare/jobs/c9837cbc4d806af2aff6/) United States ### [Associate Analyst, Provider Configuration](https://jobs.opennash.com/companies/molina-healthcare/jobs/8536d4cf5ecef9181415/) United States ### [Care Manager (BH Licensed) - Flagler County, FL](https://jobs.opennash.com/companies/molina-healthcare/jobs/5fc57ff9bc661bbf1b72/) United States ### [Care Manager (LPN/LVN) - Lake County, FL](https://jobs.opennash.com/companies/molina-healthcare/jobs/aefbfa9559013940641d/) United States ### [Care Manager (RN) - Volusia County, FL](https://jobs.opennash.com/companies/molina-healthcare/jobs/0979a31a8f6cd73806df/) United States ## Similar jobs at other companies ### [Registered Nurse Field Clinician - Richmond, VA - Senior Community Care](https://jobs.opennash.com/companies/unitedhealth-group/jobs/09739dff80d59d30e982/) UnitedHealth Group · Richmond, Virginia ### [Clinical Review Clinician - Appeals](https://jobs.opennash.com/companies/centene/jobs/41a6c8156fd6591abf3b/) Centene · Remote-NY ### [Utilization & Review Clinician (MSW)](https://jobs.opennash.com/companies/universal-health-services/jobs/5af9905fde45830e371e/) Universal Health Services · SACRAMENTO, California ### [Quality Review Specialist](https://jobs.opennash.com/companies/huntington-bank/jobs/9e051876131c2fbf1aea/) Huntington Bank · Columbus, OH ### [Insp Material Review Board](https://jobs.opennash.com/companies/lockheed-martin/jobs/6a8e095630beb855964e/) Lockheed Martin · Stratford, CT OpenNash lists jobs from employers’ own careers sites and does not handle applications. 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