Job Details

Job Title: Care Review Processor I

Location: Fully Remote

Duration: 3 Months+ (Possible Extension)



Job Description:

• Services works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential.


• Staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.


• As part of this role, the selected candidate will be scheduled to work weekends in alignment with department coverage needs.

• 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 Client operational timeframes.


• Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.

• 3+ years experience in an administrative support role in healthcare, Medical Assistant preferred

• HS Diploma or GED

• Associate degree