Job Details

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.