Senior Care Review Processor

Job Description 
 

Job Summary 
Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals. 
  Knowledge/Skills/Abilities 
• Provides computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: eligibility and benefits verification, provider contracting status, and diagnosis and treatment requests. 
• Provides the following additional data entry: Coordination of Benefits status determination, hospital census information regarding admissions and discharges, and billing codes. 
• Responds to requests for authorization of services submitted via phone, fax and mail according to Molina operational timeframes. 
• Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care. 
• Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.. 
 

Job Qualifications

Required Education
Associate's Degree or equivalent combination of education and experience
Required Experience
1-3 years
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
3-5 years
Preferred License, Certification, Association
Certification in Coding, auditing or billing

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.