• Care Review Clinician LPN / LVN

    Molina Healthcare (Rio Rancho, NM)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
    Molina Healthcare (09/25/25)
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  • Care Review Clinician - Resident…

    Molina Healthcare (Albuquerque, NM)
    **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or medical clinic… more
    Molina Healthcare (09/27/25)
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  • Care Review Clinician , PA (RN)

    Molina Healthcare (Rio Rancho, NM)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE**… more
    Molina Healthcare (08/08/25)
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  • Care Review Clinician (RN) (Must…

    Molina Healthcare (NM)
    **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At least 2… more
    Molina Healthcare (10/02/25)
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  • Sr. VP Medical Director

    Sedgwick (Santa Fe, NM)
    …(10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control. **Skills & ... criteria; to provide leadership within the dedicated team of clinician and claim professionals in support of the dedicated...+ Knowledge of ADAA and FMLA + Knowledge of utilization review procedures + Knowledge of clinical… more
    Sedgwick (09/16/25)
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