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**REMOTE** Health Care Review Processor

Location : REMOTE
Job Type : Contract
Reference Code : 16327
Hours : Full Time
Required Years of Experience : 2+
Required Education : HS diploma or equivalent
Travel : No
Relocation : No

Job Description :

Major healthcare organization has some exciting opportunities for contracted Care Review Processors to work remote supporting their Care Access and Monitoring team remotely.  


This is a REMOTE contract position currently budgeted at $17/hour for 12 months with the potential for contract extension or a permanent hire based on performance!





The Care Review Processor will work with the Healthcare Services (HCS) group. 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.


Typical day-to-day duties include but are not limited to the following:

  • 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 Qualifications :


  • HS Diploma or GED Required, Associate Degree Preferred

  • 1-3 years of experience in an administrative support role in healthcare is Required, Medical Assistant experience is preferred.

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* Your eligibility for benefits depends upon your placement, hours billed and length of service. Your recruiter can identify the programs for which you are eligible. The Company reserves the right to modify or eliminate any of its non-legally mandated benefits at any time.