Care Review Processor (PST or CST Hours)

Molina Healthcare • Phoenix, AZ • 4h ago

Molina Healthcare is hiring several Care Review Processors. These roles are remote and can be worked in a variety of states within the US.

Highly qualified candidates will have the following:

Healthcare knowledge or background either clinical (Medical Assistant) or in an administrative capacity

Experience working in a fast paced, high-volume environment with priorities that may change

High level critical thinking skills

Above average computer skills

Adaptability and attention to detail

Ability to work either 830am-530 pm Monday through Friday or Tuesday through Saturday.

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.

Required Education : HS Diploma or GED

Preferred Education : Associate Degree

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

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

Same Posting Description for Internal and External Candidates

Pay Range: $21.16 - $31.71 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Similar Jobs

LOA & ADA Specialist

Robert Half • Scottsdale, AZ • 29min ago

Description We are looking for a dedicated LOA & ADA Specialist to join our team in Scottsdale, Arizona. This role is essential for ensuring seamless management of employee leaves and accommodations while maintaining...

29min ago

Go to Apply

Security Guard - Construction Access Contol

Allied Universal • Mesa, AZ • 4h ago

Trucking & Construction

Company Overview: Allied Universal®, North America's leading security and facility services company, offers rewarding careers that provide you a sense of purpose. While working in a dynamic, welcoming, and collaborative...

4h ago

Go to Apply

Sales, Account Manager- Point of Care Ultrasound (Colorado, Arizona, New Mexico, Utah)

Philips • Phoenix, AZ • 4h ago

Hospital & Medical

Sales, Account Manager- Point of Care Ultrasound (Colorado, Arizona, New Mexico, Utah) The Point of Care Ultrasound Account Manager is the key interface between Philips and its customers. You will represent Philips' prod...

4h ago

Go to Apply

NetSuite Sales Account Manager - Denver

Oracle • Phoenix, AZ • 4h ago

Management & Administrative

Job Description About Oracle NetSuite Founded in 1998, Oracle NetSuite was the first cloud company - ushering in the new era of cloud computing. NetSuite's mission is to deliver one system, the suite, that gives leaders...

4h ago

Go to Apply

Care Connections Member Advocate Representative - Must Be Bilingual in (Spanish, Cantonese, Russian, Tagalog) - Pacific Time Zone Hours

Molina Healthcare • Mesa, AZ • 4h ago

Retail & Hospitality

Job Description Job Summary Makes outbound calls to members, completes assigned hand-dial lists, and provides proactive member support, information, and assistance. Adheres to member interaction departmental standards, c...

4h ago

Go to Apply

Care Connections Member Advocate Representative - Must Be Bilingual in (Spanish, Cantonese, Russian, Tagalog) - Pacific Time Zone Hours

Molina Healthcare • Chandler, AZ • 4h ago

Retail & Hospitality

4h ago

Go to Apply

Principal Software Engineer

Oracle • Phoenix, AZ • 4h ago

IT & Engineering

Job Description Oracle Health Application and Infrastructure is a new line of business that strives to apply our expertise in IaaS and SaaS to transform the health care industry, provide patient-centric care and make the...

4h ago

Go to Apply

Care Connections Member Advocate Representative - Must Be Bilingual in (Spanish, Cantonese, Russian, Tagalog) - Pacific Time Zone Hours

Molina Healthcare • Scottsdale, AZ • 4h ago

Retail & Hospitality

4h ago

Go to Apply