Care Review Clinician (RN)

Company: Molina Healthcare
Location: Fort Worth
Posted on: January 2, 2026

Job Description:

Job Description JOB DESCRIPTION /n Job Summary /n /n 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. /n Essential Job Duties /n • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. /n • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. /n • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. /n • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. /n • Processes requests within required timelines. /n • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. /n • Requests additional information from members or providers as needed. /n • Makes appropriate referrals to other clinical programs. /n • Collaborates with multidisciplinary teams to promote the Molina care model. /n • Adheres to utilization management (UM) policies and procedures. /n Required Qualifications /n • 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. /n • Registered Nurse (RN). License must be active and unrestricted in state of practice. /n • Ability to prioritize and manage multiple deadlines. /n • Excellent organizational, problem-solving and critical-thinking skills. /n • Strong written and verbal communication skills. /n • Microsoft Office suite/applicable software program(s) proficiency. /n Preferred Qualifications /n • Certified Professional in Healthcare Management (CPHM). /n • Recent hospital experience in an intensive care unit (ICU) or emergency room. /n /n Preferred Experience /n Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. /n /n MULTI STATE / COMPACT LICENSURE /n Individual state licensures which are not part of the compact states are required for: CA, NV, IL, NY and MI /n /n /n WORK SCHEDULE: Tues - Sat shift will rotate with some holidays. /n Training will be held Mon - Fri /n /n To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. /n Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Keywords: Molina Healthcare, Fort Worth , Care Review Clinician (RN), Healthcare , Fort Worth, Texas