[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 · Detroit, MI # Care Review Clinician (RN) - must reside in Michigan Detroit, MI, United States Healthcare & Clinical Listed on Molina Healthcare’s official careers site. Posted October 8, 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/2039501) [OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / Care Review Clinician (RN) - must reside in Michigan ## 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 Michigan health plan. The normal schedule is Monday through Friday. However, the team rotates working on holidays. Overtime may be required to meet mandatory compliance requirements as needed. ### 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 - Recent hospital experience in an intensive care unit (ICU) or emergency room. - Prior experience in utilization management and/or case management is 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 8, 2026 - First seen by OpenNash: Oct 11, 2026 - Last checked: Oct 18, 2026 - Listed for: 10 days - Location: Detroit, MI, United States[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039501) ## More jobs at Molina Healthcare ### [Care Manager (RN) Remote (Detroit, MI)](https://jobs.opennash.com/companies/molina-healthcare/jobs/b0195e9cb3fa9f52054d/) Detroit, MI, United States ### [Care Manager, LTSS (RN) (must reside in Michigan)](https://jobs.opennash.com/companies/molina-healthcare/jobs/199516b983431b17717e/) Detroit, MI, United States ### [Care Manager, LTSS (Wayne County - Michigan)](https://jobs.opennash.com/companies/molina-healthcare/jobs/b3aa7790c0094d0b1403/) Detroit, MI, United States ### [Care Manager, LTSS (must reside in Michigan)](https://jobs.opennash.com/companies/molina-healthcare/jobs/10f2d6123ae6bcda318c/) Detroit, MI, United States ## Similar jobs at other companies ### [Care Management Associate- OhioRISE - must reside in Ohio](https://jobs.opennash.com/companies/cvs-health/jobs/4d3eb798b52bb09d97c7/) CVS Health · Field-Ohio ### [Registered Nurse Field Clinician - Richmond, VA - Senior Community Care](https://jobs.opennash.com/companies/unitedhealth-group/jobs/09739dff80d59d30e982/) UnitedHealth Group · Richmond, Virginia ### [Utilization Review Clinician - ABA](https://jobs.opennash.com/companies/centene/jobs/81da71fe8a8bf02c5ebc/) Centene · Remote-GA +1 more ### [Utilization Review Clinician - Behavioral Health](https://jobs.opennash.com/companies/centene/jobs/4906acf112bc0592d0de/) Centene · Remote-MO ### [Utilization & Review Clinician (MSW)](https://jobs.opennash.com/companies/universal-health-services/jobs/5af9905fde45830e371e/) Universal Health Services · SACRAMENTO, California OpenNash lists jobs from employers’ own careers sites and does not handle applications. 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