Care Review Processor

Are you passionate about making a positive impact in the lives of others? Do you have a strong attention to detail and a desire to ensure quality care for individuals in need? If so, Molina Healthcare is looking for a dedicated and experienced Care Review Processor to join our team. As a Care Review Processor, you will play a crucial role in assessing and reviewing healthcare services to ensure the best possible outcomes for our members. If you are a compassionate and detail-oriented individual with a background in healthcare, we invite you to apply for this exciting opportunity.

1. Conduct comprehensive reviews of medical records and healthcare services to ensure compliance with industry standards and company guidelines.
2. Collaborate with healthcare providers to obtain necessary information and documentation for review.
3. Analyze and evaluate medical records, treatment plans, and diagnoses to determine appropriateness and quality of care.
4. Identify potential risks and issues in healthcare services and communicate them to appropriate parties.
5. Utilize industry knowledge and guidelines to make informed decisions about the medical necessity and effectiveness of treatments.
6. Maintain accurate and detailed records of all review activities and findings.
7. Communicate review outcomes and recommendations to healthcare providers, members, and other stakeholders.
8. Participate in team meetings and training sessions to stay updated on industry changes and best practices.
9. Follow all HIPAA and confidentiality guidelines in handling sensitive healthcare information.
10. Collaborate with other team members to ensure timely and accurate completion of all reviews.
11. Act as a resource for members and providers in answering questions and addressing concerns related to care review processes.
12. Continuously monitor and evaluate care review processes and procedures to identify areas for improvement.
13. Maintain a positive and professional working relationship with team members, members, and providers.
14. Adhere to all company policies and procedures related to care review processes and responsibilities.

According to JobzMall, the average salary range for a Care Review Processor is $35,000 to $50,000 per year. However, this can vary depending on the specific company, location, and level of experience. Some companies may offer higher salaries or additional benefits such as bonuses or healthcare plans. It is important to research the specific company and job offer to get a more accurate salary range.

Molina Healthcare is a managed care company headquartered in Long Beach, California, United States. The company provides health insurance to individuals through government programs such as Medicaid and Medicare.