Care Review Processor I


Website Administrative

Reference Code: 4913

Position Title: Care Review Processor I
Location: REMOTE, PST time, Long Beach, CA, 90902
4/5/2021 – 4/4/2022 possible extension

This will be 100% remote
Candidates need to be available o work M-F 8:30 am- 5:30 pm PST
This is a NON Clinical role

Job Summary
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. HCS 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.

• 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 by the Medical Director.

Job Qualifications
Required Education: HS Diploma or GED
Required Experience: 1-3 years experience in an administrative support role in healthcare.
Required License, Certification, Association n/a
Preferred Education: Associate's Degree
Preferred Experience: 3+ years experience in an administrative support role in healthcare, Medical Assistant preferred.
Preferred License, Certification, Association n/a



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