Job Details

Care Review Processor

Molina Healthcare is hiring a Care Review Processor. This role is remote to anyone living in the state of Idaho. Highly qualified candidates will have the following: healthcare knowledge or background either clinical or in an administrative capacity, experience working in a fast paced, high-volume environment with priorities that may change, high level critical thinking skills, above average computer skills, adaptability and attention to detail, and must live in the state of Idaho.

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.

Knowledge/Skills/Abilities:

• Provides telephone, clerical, and data entry support for the Case Management team.
• Responsible for initial review of assigned case levels to assist in Case Management assignment.
• Reviews data to identify principal member needs and works under the direction of the Case Manager to implement care plan.
• Schedules member visits with team members as needed.
• Screens members using Molina policies and processes, assisting clinical Case Management staff as they identify appropriate medical services.
• Coordinates required services in accordance with member benefit plan.
• Promotes communication, both internally and externally to enhance effectiveness of case management services.
• Processes member and provider correspondence.

Job Qualifications:

• Required Education: HS Diploma or GED
• Preferred Education: Associate degree
• Required Experience: 1-3 years' experience in an administrative support role in healthcare
• Preferred Experience: 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

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: $13.41 - $29.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.