Care Review Processor

Molina Healthcare; Long Beach, Northern (CA, KY); Hybrid; USD 276,000 - 4,187,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a non-clinical administrative support specialist to assist the utilization management team. You will handle telephone support, data entry, and provider inquiries to help coordinate approval processes and care delivery.

The role emphasizes accuracy, confidentiality, and the ability to manage multiple letters and deadlines in a fast-paced health care environment. Strong Microsoft Office skills and clear written communication are essential.

Qualifications

• 1+ year administrative support in healthcare or related field.
• Demonstrates accuracy and attention to detail in correspondence.
• Ability to manage multiple letters and deadlines with diligence.
• Excellent verbal and written communication skills.
• Willingness to learn new software and lines of business.
• Maintains confidentiality and regulatory compliance in processing letters.

Responsibilities

• Provides telephone, clerical and data entry support for the care review team.
• Enters authorizations and provider inquiries, verifies eligibility and benefits.
• Responds to service authorization requests submitted by phone, fax, or mail.
• Contacts physician offices to request missing information and clarification.

Skills

Administrative support

Attention to detail

Organization

Communication skills

Time management

Confidentiality

Regulatory compliance

Team collaboration

Adaptability

Research

Tools

Microsoft Office

Job description

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

• At least 1 year of experience in an administrative support role, preferably within a health care environment supporting correspondence or clinical communications, or equivalent combination of relevant education and experience.
• Strong attention to detail, and ability to work within regulatory and internal requirements for letter generation.
• Strong organizational and time-management skills, and ability to manage multiple letter queues and deadlines.
• Excellent verbal and written communication skills, and ability to ensure clarity and precision in all correspondence.
• Willingness to learn and adapt to new programs, software systems, and lines of business.
• Ability to research, obtain feedback, and integrate necessary adjustments into letters to meet quality standards.
• Ability to manage multiple tasks simultaneously, and ensure quality and compliance in all produced correspondence.
• Ability to maintain confidentiality and ensure compliance with all relevant guidelines, regulations, and policies in processing of clinical correspondence.
• Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet deadlines.
• Ability to collaborate effectively with team members and internal departments.
• Basic Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

• Previous experience in a health care correspondence or clinical communications role, with an understanding of regulatory and accreditation rules related to clinical determinations.

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

Pay Range: $20.34 - $30.39 / HOURLY

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