Care Review Processor II (Remote - Temp to Perm)
Care Review Processor II (Remote - Temp to Perm) Pay Rate: $22.00/hour Start Date: April 28, 2025 Schedule: Monday - Friday, 8:30 AM - 5:30 PM PST Location: Remote (must reside in one of the following states: AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater NYC), OH, TX, UT, WA (outside greater Seattle), WI)
A leading Managed Care Organization is seeking a Care Review Processor II to support their Care Access and Monitoring (CAM) team. This role plays a vital part in ensuring the timely and accurate processing of authorization requests and supporting utilization management functions. This is a remote, temp-to-perm opportunity with potential for long-term employment based on performance.
Key Responsibilities:Review and process authorization requests received by phone, mail, and fax.
Verify member eligibility, benefits, and provider contracting status.
Assign appropriate billing codes (ICD-9/ICD-10 and CPT/HCPC).
Confirm coordination of benefits (COB) and inpatient census data.
Communicate with providers to gather missing or additional information.
Maintain accurate documentation in the system and meet productivity standards.
Notify case managers and nurses of hospital admissions and member status changes.
Collaborate with interdepartmental teams to ensure continuity of care.
Deliver excellent customer service to both internal and external stakeholders.
Maintain confidentiality and adhere to HIPAA and company compliance standards.
High School Diploma or GED required.
2-4 years of experience in a Utilization Review Department within a Managed Care setting.
Prior experience in a hospital, healthcare billing, or clerical environment.
Familiarity with medical terminology, UM (Utilization Management), and prior authorization processes.
Strong data entry skills (minimum 40 WPM) and proficiency in Microsoft Office.
Must be detail-oriented, analytical, and comfortable working in a fast-paced, remote setting.
Ability to work PST hours regardless of home time zone.