[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) (Utilization Management) United States Full-time Executive & Management Listed on Molina Healthcare’s official careers site. Posted October 28, 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/2039720) [OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / Care Review Clinician (RN) (Utilization Management) ## 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. This position supports the Molina New Mexico Healthcare Inc. state plan. The ideal candidate will have SDCB, ABCB, INF experience. ### 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. - SDCB, ABCB, INF experience preferred - Utilization Management Reviewer experience and understanding of the New Mexico Medicaid policies and procedures strongly preferred. ### 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 28, 2026 - First seen by OpenNash: Nov 1, 2026 - Last checked: Nov 1, 2026 - Listed for: 4 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/2039720) ## 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 ### [Behavioral Health & Project Management Internship (Remote) – Summer 2027 (Undergraduate)](https://jobs.opennash.com/companies/molina-healthcare/jobs/f1b0a1d5c3efc703c0e4/) United States ### [Care Manager, Health Management](https://jobs.opennash.com/companies/molina-healthcare/jobs/710f2b39d2843aace89d/) United States ### [Director, Configuration (EDI & Inbound Claims)](https://jobs.opennash.com/companies/molina-healthcare/jobs/c797d2e40e8b81959a51/) United States ### [Lead Analyst, Vendor Management](https://jobs.opennash.com/companies/molina-healthcare/jobs/ebe05a01c6aeb2c7b4cb/) United States ### [Manager, Health Plan Provider Contracts](https://jobs.opennash.com/companies/molina-healthcare/jobs/241e57d5fb9e14702507/) United States ## Similar jobs at other companies ### [Utilization Management Nurse Consultant - Medical Review (Remote)](https://jobs.opennash.com/companies/cvs-health/jobs/657e2f8c3efcdadd0982/) CVS Health · Work At Home-Missouri ### [Utilization & Review Clinician (MSW)](https://jobs.opennash.com/companies/universal-health-services/jobs/5af9905fde45830e371e/) Universal Health Services · SACRAMENTO, California ### [Utilization Review (UR) / Utilization Management (UM) Coordinator](https://jobs.opennash.com/companies/universal-health-services/jobs/79fa92cc6390f65ef73b/) Universal Health Services · MOULTRIE, Georgia ### [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. 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