- Molina Healthcare (Jacksonville, FL)
- …experience. + Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state ... applicable policies/protocols. **REQUIRED QUALIFICATIONS:** + At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical… more
- Molina Healthcare (Jacksonville, FL)
- …Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer . * Evaluates authorization requests in timely support ... of nurse reviewers, reviews cases requiring concurrent review and manages...appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency,… more
- Molina Healthcare (Jacksonville, FL)
- …committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer . + Evaluates authorization requests in timely support of ... nurse reviewers; reviews cases requiring concurrent review, and manages...appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency,… more
- Molina Healthcare (Jacksonville, FL)
- …Communicates with the Molina Plan Senior Leadership Team, including the Plan President, Chief Medical Officer , national Risk Adjustment teams and strategic teams ... LICENSE, CERTIFICATION, ASSOCIATION:** * Certified Professional in Health Quality (CPHQ) * Nursing License (RN may be preferred for specific roles) * Certified Risk… more