Care Review Processor-Utilization Review-California

Molina Healthcare

Posted about 1 month ago

Full Time

Long Beach, California

In Person

Smart Summary

The Care Review Processor provides administrative support to the utilization management team, including data entry and responding to authorization requests. They also contact physician offices for additional information as needed.

We are looking for someone with at least one year of administrative support experience, ideally in a healthcare setting, to provide non-clinical assistance to the utilization management team. Strong communication, organizational skills, attention to detail, and proficiency in Microsoft Office are essential for success in this role.

Must Have Skills for ATS

Attention To Detail

Organizational Skills

Time Management

Verbal Communication

Written Communication

Research Skills

Confidentiality

Collaboration

Microsoft Office Proficiency

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. 
• Previous experience as a Correspondence Processor at Molina. 
• 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. 

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 – 8:30 AM
  • Schedule: Friday to Monday
  • 4 days / 10-hour shifts

Fourth Position

  • Mid Shift: 10:00 AM – 8:30 PM
  • Schedule: Saturday to Tuesday
  • 4 days / 10-hour shifts

    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. 

    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

Molina Healthcare

Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care. Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.

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