Care Review Processor with Managed Care Exp. -- Remote | WFH - #9835161

Get.It Recruit - Administrative


Date: 3 days ago
City: Long Beach, CA
Contract type: Full time
Remote
Join our dedicated team in a pivotal role that supports our mission to deliver high-quality, cost-effective healthcare services. As a Care Review Processor, you will be integral to our Care Access and Monitoring (CAM) team, providing essential clerical support and data management for members requiring hospitalization and other healthcare services. This position is remote, offering a flexible schedule with the necessity to accommodate PST working hours.

Responsibilities

Data Management: Accurately enter necessary information into our systems from various sources and verify member eligibility and coverage.

Communication: Handle inbound inquiries via phone, mail, or fax, ensuring timely and accurate responses. Generate correspondence with attention to detail in selecting templates and checking grammar.

Support and Coordination: Assist in managing authorization requests and provider inquiries, assigning billing codes, verifying service requests, and coordinating with healthcare providers to obtain additional information as needed.

Team Collaboration: Work closely with interdepartmental teams to support the continuity of care for members across behavioral health and long-term care services.

Quality and Compliance: Adhere to department standards for quality assurance, participate in required training, and maintain strict confidentiality in compliance with HIPAA regulations.

Schedule

Primary: Tuesday to Saturday, 10:00 AM - 6:30 PM PST

Alternate: Sunday to Thursday, 10:00 AM - 6:30 PM PST

Flexibility to work additional hours and weekends as needed.

Qualifications

Minimum of 2 years' experience in a Utilization Review role within a Healthcare Managed Care environment.

Familiarity with hospital or healthcare settings, including clerical, audit, or billing roles.

Proficient in medical terminology and Microsoft Office suite.

Strong typing skills (minimum 40 WPM).

Effective communication skills and the ability to work independently or as part of a team.

High School Diploma or GED required; some college education preferred.

Technology Requirements

Provided equipment includes a laptop, keyboard, mouse, headset, and dual monitors for optimal performance.

Job Perks

Opportunity for contract extension or transition to permanent employment based on performance.

Fully remote role, promoting work-life balance.

Competitive hourly rate and structured training for professional development.

Application Process

Interested candidates should apply with a resume and cover letter. Selected candidates will be invited for a video interview via Teams.

Employment Type: Full-Time

How to apply

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