All roles

Open role

Care Review Processor - Remote

Remote · Malaysia Full-time

JOB DESCRIPTION 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.

Required Qualifications• 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.

Preferred Qualifications

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

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

More open positions

Influencer Talent Manager - Berlin

Work from home Full-time role

Influencer Talent Manager - Amsterdam

Work from home Full-time role

Influencer Talent Manager - Brazil

Work from home Full-time role

Account Manager

Work from home Full-time role

Account Manager

Work from home Full-time role

Field Service Engineer

Work from home Full-time role

Tech Lead, Web Core Product & Chrome Extension - Galway, Ireland

Work from home Full-time role

Part-Time Remote Instructional Designer for E-Learning Development and LMS Migration Project

Work from home Full-time role

Shopify Website Manager

Work from home Full-time role

[Remote] Senior Software Engineer

Work from home Full-time role

Experienced Full Stack FIU Director – Customer Risk Management (Remote)

Work from home Full-time role

[Remote] Principal GenAI Data Engineer

Work from home Full-time role

Senior Global Account Payable Specialist

Work from home Full-time role

[Remote] Lead AI ML Engineer

Work from home Full-time role

Senior Field Sales Representative ( Next Gear)

Work from home Full-time role

Experienced Full Stack Customer Support Representative – Amazon Chat Support in Canada

Work from home Full-time role

Sr. Account Manager – Centene - Accredo - Remote

Work from home Full-time role

Finance Manager

Work from home Full-time role

Bilingual Medical Operator

Work from home Full-time role

Remote Medical Coder

Work from home Full-time role

Part-Time Remote Live Chat Representative – Automotive Dealer Customer Engagement & Lead Generation

Work from home Full-time role