Care Review Processor (Remote)

Job Summary

Provides 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

Preferred Qualifications

To all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V Pay Range : $21.16 - $31.71 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.