Healthcare - Care Review Processor I

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.

3 years relevant experience previous IPA health plan preferred.

Minimum 3 months assignments longer if needed

Required Licensure / Education: High School diploma

Is this a temp to hire position? No

Location: Remote Base California preferred

Must Have Skills: · 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, coordination of benefits status determination, hospital census information regarding admissions and discharges. · Responds to requests for authorization of services submitted via fax according to Molina operational timeframes. · Assistance with Calls outs, clerking faxes, and creating shells in the system. Identifying IPA delegations and Knowledge of DOFRs.