Care Review Clinician (RN) - must reside in Michigan

Company: Molina Healthcare | Location: Detroit, MI | Salary: $26 to $51 per hour | Employment: Full-time | License: RN | State licensure: 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 regu