Healthcare - Care Review Processor I

Job Description:
Need non-clinical support for Hospice SAI (new program).
Must work 8:30am – 5:30pm PST
will require standard equipment + dual monitors
Must live in California

Job Description:
Provide telephone, clerical and data entry support for the Molina Healthcare Services Care Management Team. Supports Care Management for all non-clinical functions.
Facilitates coordination of medical services to ensure the delivery of high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes for

• Responsible for initial review and triage of Care Management tasks.
• Reviews data to identify principle member needs and works under the direction of the Case Manager to implement care plan.
• Screens members using Molina policies and processes assisting clinical Care Management staff as they identify appropriate medical services
• Coordinates required services in accordance with member benefit plan.
• Promotes communication, both internally and externally to enhance effectiveness of case management services (e.g., health care providers and health care team members).
• Provides support services to case management team members by answering telephone calls, taking messages and researching information.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality 
• May assist in the research and resolution of claims payment issues.

Must Have Skills:
Knowledge, Skills and Abilities that are necessary to perform the job 
Satisfactorily
• Strong customer service skills to coordinate service delivery including attention to members/customers, sensitivity to concerns, proactive identification and resolution of issues to promote positive outcomes for members
• Demonstrated ability to communicate, problem solve, and work effectively with people
• Working knowledge of medical terminology and abbreviations
• Ability to think analytically and to problem solve.
• Good interpersonal/team skills
• Must have a high regard for confidential information
• Ability to work in a fast-paced environment
• Able to work independently and as part of a team.
• PC experience in Windows environment and accurate data entry at 40 WPM minimum.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Day to Day Responsibilities:
• Monitor email and fax queues for timely responses.
• Answer telephone calls, take messages, schedule physician to physician conference calls for medical director reviews.
• Collect and organize members' medical records received from providers. Contact providers and request additional med records per Medical Director's request.
• Upload members' medical records into the system for clinical reviews.
• Attend daily team meetings
• Complete all required trainings for compliance.
• Assist with creation of authorizations.

Required Years of Experience: Minimum 1 year experience. Managed Care experience is preferred.
Required Licensure / Education: High School Diploma or GED. Associate in arts degree is Preferred.