Care Review Processor (Remote) PST Hours

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 u2022 Provides telephone, clerical and data entry support for the care review team. u2022 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. u2022 Responds to requests for authorization of services submitted via phone, fax and mail according to operational timeframes. u2022 Contacts physician offices according to department guidelines to request missing information from authorization requests or for additional information as requested medical directors. Required Qualificationsu2022 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. u2022 Previous experience as a Correspondence Processor at Molina. u2022 Strong attention to detail, and ability to work within regulatory and internal requirements for letter generation. u2022 Strong organizational and time-management skills, and ability to manage multiple letter queues and deadlines. u2022 Excellent verbal and written communication skills, and ability to ensure clarity and precision in all correspondence. u2022 Willingness to learn and adapt to new programs, software systems, and lines of business. u2022 Ability to research, obtain feedback, and integrate necessary adjustments into letters to meet quality standards. u2022 Ability to manage multiple tasks simultaneously, and ensure quality and compliance in all produced correspondence. u2022 Ability to maintain confidentiality and ensure compliance with all relevant guidelines, regulations, and policies in processing of clinical correspondence. u2022 Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet deadlines. u2022 Ability to collaborate effectively with team members and internal departments. u2022 Basic Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications u2022 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 Pay Range: $21.16 - $31.71 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-10-13