Here’s a breakdown of the Molina Healthcare Care Review Processor job posting:
Job Title: Care Review Processor
Company: Molina Healthcare
Location: Remote (US-based, variety of states)
Job Type: Full Time
Pay Range: $21.16 – $31.71 / HOURLY (Actual compensation may vary based on location, experience, education, and skills)
Job Summary:
The Care Review Processor supports the Care review team by handling administrative and data entry tasks. This role is crucial in assessing, facilitating, planning, and coordinating integrated care for members with high needs.The goal is to ensure members receive medically appropriate and cost-effective quality care.
key Responsibilities:
Provide telephone, clerical, and data entry support to the Care Review team.
Enter authorization requests and provider inquiries into the system.
Verify eligibility and benefits.
Check provider contracting status.
Process diagnosis and treatment requests.
Determine coordination of benefits status.
Record hospital census details (admissions, discharges).
Enter billing codes.
Respond to service authorization requests received via phone, fax, and mail within operational timeframes.
Contact physician offices to request missing information for authorization requests or for additional details as needed by the Medical Director.
Highly Qualified Candidates will Have:
Healthcare Knowledge/Background: Clinical (medical Assistant) or administrative experience in healthcare.
Fast-Paced Environment Experience: Ability to work in a high-volume setting with changing priorities.
Critical Thinking Skills: High level of analytical and problem-solving abilities.
computer Skills: Above average proficiency.
Adaptability & Attention to Detail: Ability to adjust to changes and maintain accuracy.
Availability: Ability to work either 8:30 am – 5:30 pm Monday through Friday OR Tuesday through saturday.
Required Education:
High School Diploma or GED
Preferred Education:
Associate Degree
Required Experience:
1-3 years of administrative support experience in healthcare.
Preferred Experience:
3+ years of administrative support experience in healthcare.* Medical Assistant experience is preferred.
Company Mission & Culture:
Molina Healthcare is a Fortune 500 association dedicated to providing quality healthcare to individuals receiving government assistance. They emphasize a team-oriented environment and a mission-driven workforce focused on making a difference in the lives of others.
Benefits:
Molina healthcare offers competitive benefits and compensation packages.
Equal Opportunity Employer:
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Internal Applicants:
current Molina employees should apply through the intranet job listing.
