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Molina Healthcare Sr Care Review Processor (Weekend/Evening Shift) in Georgetown, Kentucky

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.

*Weekend and/or Weeknight Shift *


• 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.

Pay Range: $13.41 - $29.06 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.