Care Review Processor-Utilization Review-California

Molina Healthcare•Long Beach, CA

About The Position

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.

Requirements

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.

Nice To Haves

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

Responsibilities

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.