Care Review Processor

At Molina Healthcare, we are dedicated to providing high-quality, affordable healthcare services to our members. As a Care Review Processor, you will play a crucial role in ensuring that our members receive the best possible care by reviewing and coordinating their medical treatment plans. We are seeking a detail-oriented and compassionate individual with a strong background in healthcare and experience in processing care reviews. If you are passionate about making a positive impact on the lives of our members, we encourage you to apply for this exciting opportunity.

1. Conduct comprehensive reviews of medical treatment plans for Molina Healthcare members.
2. Follow established guidelines and protocols to ensure the accuracy and completeness of reviews.
3. Collaborate with healthcare providers to gather necessary information and documentation for reviews.
4. Analyze medical records and other relevant data to determine the appropriateness and effectiveness of treatment plans.
5. Communicate with members, providers, and other stakeholders to address any questions or concerns related to the review process.
6. Document all review findings and decisions accurately and in a timely manner.
7. Utilize clinical knowledge and expertise to identify potential gaps in care and make recommendations for improvement.
8. Adhere to all regulatory requirements and company policies and procedures.
9. Participate in ongoing training and development to stay current on industry best practices and updates.
10. Maintain confidentiality and handle sensitive information with discretion.
11. Support a positive and collaborative work environment by working effectively with team members and other departments.
12. Act as an advocate for members, ensuring they receive the best possible care within their plan of coverage.
13. Continuously seek opportunities to improve processes and enhance the member experience.
14. Provide excellent customer service to members and external partners, addressing any concerns or inquiries in a timely and professional manner.
15. Support the company's mission and values by upholding high standards of ethics and professionalism in all job duties.

According to JobzMall, the average salary range for a Care Review Processor is $35,000 to $60,000 per year. This can vary depending on factors such as location, experience, and specific job duties. Some positions may also offer performance-based bonuses or other benefits.

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.