Care Review Processor-Utilization Review-California

JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting provision of integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• 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 operational timeframes.
• Contacts physician offices according to department guidelines to request missing information from authorization requests or for additional information as requested medical directors.

Required Qualifications

Shifts Available

First Position

Dayshift : 6 : 00 AM – 2 : 30 PM

Schedule : Tuesday to Saturday

5 days / 8-hour shifts

Second Position

Dayshift : 6 : 00 AM – 4 : 30 PM

Schedule : Saturday to Tuesday

4 days / 10-hour shifts

Third Position

Night Shift : 10 : 00 PM – 6 : 30 AM

Schedule : Tuesday to Saturday

5 days / 8-hour shifts

Fourth Position

Evening Shift : 2 : 00 PM – 12 : 30 AM

Schedule : Friday to Monday

4 days / 10-hour shifts

Preferred Qualifications

#PJHS

#LI-AC1

Pay Range : $20.25 - $30.39 / HOURLY