
This full-time Medical Review Nurse role within Molina Healthcare's Utilization Management team focuses on reviewing medical documentation to ensure appropriate care levels and accurate reimbursement. The position requires an active Michigan RN license and involves conducting prospective, retrospective, and concurrent reviews of appeals for denied prior authorizations and claims. Key responsibilities include validating medical records against federal and state guidelines, resolving escalated utilization complaints, and presenting complex cases for administrative hearings. The role appeals to experienced nurses seeking to leverage clinical expertise in a remote-friendly environment that values professional growth, offering opportunities to mentor peers and serve as a clinical resource while contributing to high-quality patient care standards.

















