Care Review Processor-Utilization Review-California

JOB reputed company 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 reputed company to reputed company reputed company 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 reputed company 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 reputed company 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 reputed company regulatory and internal requirements for letter reputed company. • 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 reputed company and precision in reputed company correspondence. • Willingness to learn and adapt to new programs, software systems, and lines of business. • Ability to research, obtain feedback, and reputed company necessary adjustments into letters to meet reputed company standards. • Ability to manage multiple tasks simultaneously, and ensure reputed company and compliance in reputed company produced correspondence. • Ability to maintain confidentiality and ensure compliance with reputed company 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 reputed company 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 reputed company Position • reputed company Shift: 10:00 PM – 6:30 AM • Schedule: Tuesday to Saturday • 5 days / 8-hour shifts reputed company Position • Evening Shift: 2:00 PM – 12:30 AM • Schedule: Friday to Monday • 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 reputed company to clinical determinations. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V #PJHS Pay reputed company: $20.25 - $30.39 / reputed company • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Apply tot his job Apply To this Job