Care Review Clinician — Utilization Management (RN), Remote

Molina Healthcare
Remote (U.S.) — Passport Health Plan by Molina Healthcare, Kentucky Medicaid market Full-time Oct 8, 2026 utilization review nurseRNcare review clinicianremote nursingmanaged caremedicaidmolina healthcare
$23.76–$51.49/hour

About the role

Molina Healthcare is hiring a remote Care Review Clinician to handle prior-authorization and utilization review for its Passport Health Plan Medicaid line. You'll weigh incoming clinical requests against evidence-based guidelines, loop in a Medical Director on the tougher calls, and help members get the right level of care — all from a home office anywhere in the U.S., as long as you hold an active RN license (a behavioral-health license also qualifies for BH reviews).

Responsibilities

  • Review incoming prior-authorization and utilization requests against evidence-based clinical guidelines to confirm medical necessity
  • Verify member eligibility and benefits before approving or routing a request
  • Process authorization decisions within required turnaround windows
  • Reach out to members and providers when a review needs more clinical information
  • Refer complex or borderline cases to a Medical Director with a clear clinical summary
  • Connect members with appropriate clinical programs and services based on review findings
  • Partner with multidisciplinary care teams to keep utilization management moving smoothly

Requirements

  • Active, unrestricted RN license in your state of practice (a behavioral-health license also qualifies for BH-focused reviews)
  • 2+ years of experience in hospital acute care, inpatient review, prior authorization, or managed care
  • Strong organizational skills and comfort juggling multiple review deadlines at once
  • Solid written and verbal communication for provider- and member-facing conversations
  • Working knowledge of Microsoft Office and standard clinical documentation software
  • CPHM certification or recent ICU/ER experience a plus

What we offer

  • $23.76–$51.49/hour, based on location, experience and licensure
  • Medical, dental, vision and voluntary life insurance, plus pet insurance
  • 401(k) and Roth 401(k) with company match, and an employee stock purchase plan
  • Paid time off, volunteer time off, and paid company holidays
  • Tuition and continuing-education reimbursement
  • Employee assistance and well-being programs
$23.76–$51.49/hour Apply now
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