[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 or BH Licensed) United States Listed on Molina Healthcare’s official careers site. Posted September 17, 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/2038683) [OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / Care Review Clinician (RN or BH Licensed) ## 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: Sep 17, 2026 - First seen by OpenNash: Oct 11, 2026 - Last checked: Oct 18, 2026 - Listed for: 31 days - Location: United States[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2038683) ## More jobs at Molina Healthcare ### [AVP, Infrastructure (IaC / Multi-Cloud Architecture / AI) - REMOTE](https://jobs.opennash.com/companies/molina-healthcare/jobs/64cd5b780c698a44504e/) United States ### [Account Manager, Medicare Sales (remote)](https://jobs.opennash.com/companies/molina-healthcare/jobs/0ca366a1a7eb4a8654c9/) United States ### [Analyst, Business - Advanced Excel (Remote)](https://jobs.opennash.com/companies/molina-healthcare/jobs/aa3ea7b827dbf5a2ebd6/) United States ### [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 ## Similar jobs at other companies ### [Customer Care Professional-Annuities, Licensed, Remote](https://jobs.opennash.com/companies/thrivent-financial/jobs/579f82c300b2d7ca3ab1/) Thrivent Financial · United States ### [Associate Customer Care Professional-Annuities, Licensed, Remote](https://jobs.opennash.com/companies/thrivent-financial/jobs/92934967dd9f046af0da/) Thrivent Financial · United States ### [Vision Center Manager L3 - Licensed - 1362](https://jobs.opennash.com/companies/walmart/jobs/3163a629131cd0a156c4/) Walmart · United States ### [Licensed Behavioral Health Clinician - LCSW, LPC or LMFT](https://jobs.opennash.com/companies/unitedhealth-group/jobs/b0610c8d97ebcefd4dc2/) UnitedHealth Group · Bristol, Connecticut ### [Registered Nurse Field Clinician - Richmond, VA - Senior Community Care](https://jobs.opennash.com/companies/unitedhealth-group/jobs/09739dff80d59d30e982/) UnitedHealth Group · Richmond, Virginia 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 Jobs · Official listings with dates and links to the employer. [Weekly hiring report](/reports/hiring/) · [Methodology](/methodology/)