Travel · Job #272320

Prior Authorization-Utilization Review Nurse-Must be CA licensed RN-Remote

Travel Oct 17, 2026

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Quick Overview

Type

Travel

Start Date

Oct 17, 2026

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Prior Authorization-Utilization Review Nurse-Must be CA licensed RN-Remote · United States

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About This Position

Care Review Clinician (UM RN) Large Managed Care Company

Fully Remote

3-month contract-Strong potential for extension and/or perm hire

3 full-time positions to fill

Must be a licensed RN in CA

Rotating schedule Sun-Sat 6am-6pm PST

Schedules will be monthly and flexible

up to $46 an hour

Day to Day Responsibilities: Medical necessity clinical review or services requiring prior authorization Must Have Requirements: Health Plan or IPA experience performing prior authorization review, CA RN license

KNOWLEDGE/SKILLS/ABILITIES

Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

Identifies appropriate benefits and eligibility for requested treatments and/or procedures.

Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.

Processes requests within required timelines.

Refers appropriate prior authorization requests to Medical Directors.

Requests additional information from members or providers in consistent and efficient manner.

Makes appropriate referrals to other clinical programs.

Collaborates with multidisciplinary teams to promote Molina Care Model

Adheres to UM policies and procedures.

#ALLJ

Pay: Up to $46.00 per hour

Expected hours: 40.0 per week

Benefits:

401(k)

Health insurance

Work Location: Remote

Experience

Insurance prior authorization, Managed care, RN License, Managed care organization experience, Pre-authorization review for utilization management, Utilization management, Milliman Care Guidelines (MCG Health), Nursing