Care Review Processor

Molina Healthcare is seeking a detail-oriented Care Review Processor to provide administrative support to its Utilization Management team. This role plays an important part in supporting healthcare operations by managing authorization requests, provider communications, data entry, and documentation processes to help deliver quality and cost-effective member care.

The ideal candidate will have strong organizational skills, excellent communication abilities, and experience handling confidential information in a fast-paced healthcare environment. The successful candidate will support care review operations by processing requests, maintaining accurate records, and ensuring compliance with internal and regulatory requirements.

Key Responsibilities:

• Provide telephone, clerical, and data entry support to the Care Review team.

• Enter authorization requests, provider inquiries, eligibility details, benefits verification, and treatment information into computer systems.

• Process information related to provider contracting status, diagnosis requests, coordination of benefits, hospital admissions, discharges, and billing codes.

• Respond to authorization requests received through phone, fax, and mail within required timelines.

• Contact physician offices to request missing information or additional documentation required for review.

• Maintain accurate records and ensure all correspondence meets quality standards.

• Support administrative processes while maintaining confidentiality of member information.

Requirements:

• Minimum 1 year of experience in an administrative support role, preferably within healthcare correspondence or clinical communications.

• Strong attention to detail and ability to follow regulatory and internal requirements.

• Excellent organizational and time-management skills.

• Strong verbal and written communication abilities.

• Ability to manage multiple tasks, deadlines, and correspondence queues.

• Willingness to learn new programs, software systems, and healthcare processes.

• Ability to research information, apply feedback, and improve documentation quality.

• Strong ability to maintain confidentiality and follow healthcare compliance guidelines.

• Ability to work effectively in a high-volume and fast-paced environment.

• Basic proficiency in Microsoft Office Suite and related software.

• Strong knowledge of:

• Healthcare administrative processes and documentation.

• Authorization requests and provider communications.

• Clinical correspondence standards and regulatory compliance.

Preferred Qualifications:

• Previous experience in healthcare correspondence or clinical communication roles.

• Understanding of regulatory and accreditation requirements related to healthcare determinations.