Care Review Processor

Job Description

Job Description

The Case Review Processor will be working 100% remote but reside within the state of MI. Our Case Review Processor will be working with our MI Medicaid members and supporting our Care Review Clinicians. This individual will be working in various databases being able to sort, filter, analyze and complete data entry. We are looking for candidates with excellent technology skills, attention to detail, strong analytical skills, and ability to toggle back and forth between multiple screens and databases.

Home office with internet connectivity of high speed required.

Monday Friday 8 : 00 AM to 5 PM EST (No weekends or Holidays)

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Knowledge / Skills / Abilities

• Provides telephone, clerical, and data entry support for the Care Review team.
• Provides computer entries of authorization request / provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes.
• Responds to requests for authorization of services submitted via phone, fax, and mail according to Molina operational timeframes.
• Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.

Job Qualifications

Required Education

HS Diploma or GED

Required Experience

1-3 years' experience in an administrative support role in healthcare.

Preferred Education

Associate degree

Preferred Experience

3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.