Care Review Processor (PST HOURS – Prior Auth)

JOB DESCRIPTION

The position is remote and work hours are 8am-5pm PST. Will work rotating weekends and holidays

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. Will support and process prior authorizations, referral and admissions. 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.

Job Qualifications

Required Education

HS Diploma or GED

Required Experience

1-3 years’ experience in an administrative support role in healthcare.

Preferred Education

Associate degree

Preferred Experience

3 years’ experience in an administrative support role in healthcare, Medical Assistant preferred.

Prior Authorization, referral and admissions experience.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range: $18 – $26.42 / HOURLY

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