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Care Review Processor Jobs (NOW HIRING)

Kaiser Permanente

RN, Specialty Care Review

Atlanta, GA · On-site

$40.35/hr

Understands the Complex Case Management Program and referral process; Refers patients to the ... Performs quality of care and service reviews using identified quality indicators. Reviews the ...

Molina Healthcare

Care Review Clinician (RN)

Long Beach, CA · On-site

$30.37 - $59.21/hr

Job SummaryProvides support for clinical member services review assessment processes. Responsible ... Contributes to overarching strategy to provide quality and cost-effective member care. Essential ...

Molina Healthcare

Care Review Clinician (RN)

Tampa, FL

$26.41 - $51.49/hr

Job Summary Provides support for clinical member services review assessment processes. Responsible ... Contributes to overarching strategy to provide quality and cost-effective member care. Essential ...

Molina Healthcare

Care Review Clinician (RN)

Bothell, WA

$26.41 - $59.21/hr

Job SummaryProvides support for clinical member services review assessment processes. Responsible ... Contributes to overarching strategy to provide quality and cost-effective member care. Essential ...

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How much do care review processor jobs pay per hour?

As of Aug 3, 2026, the average hourly pay for care review processor in the United States is $16.74, according to ZipRecruiter salary data. Most workers in this role earn between $13.46 and $19.23 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the care review processor position, and why are they important?

A Care Review Processor requires a solid understanding of healthcare procedures, medical terminology, and insurance guidelines, typically supported by experience in medical claims or healthcare administration. Familiarity with claims management software, electronic health records (EHR) systems, and Microsoft Office is often necessary, along with knowledge of HIPAA compliance requirements. Strong attention to detail, organizational skills, and the ability to communicate effectively with medical professionals and insurance providers are vital soft skills. These competencies ensure accurate review and processing of care requests while supporting efficient, compliant healthcare operations.

What are the typical daily responsibilities of a care review processor?

As a Care Review Processor, your day-to-day responsibilities usually include reviewing medical records and authorization requests, verifying insurance coverage, ensuring documentation is complete, and coordinating with healthcare providers to clarify information. You may also be responsible for entering data into claims systems, communicating with patients or case managers, and helping to resolve discrepancies or incomplete submissions. Most of your work will involve close attention to detail and following established healthcare or insurance processes. Teamwork is often part of the role, as you may collaborate with clinicians, billing teams, and customer service representatives to facilitate accurate and timely care reviews.

What is a care review processor?

A Care Review Processor is responsible for reviewing medical claims, authorizations, and healthcare documentation to ensure accuracy, completeness, and compliance with company policies and regulations. They work with healthcare providers, insurance companies, and internal teams to process claims efficiently. Their role helps streamline patient care by validating medical necessity and ensuring proper claim adjudication. Strong attention to detail and knowledge of medical terminology are essential for success in this position.

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Care Review Processor jobs near you
Infographic showing various Care Review Processor job openings in the United States as of July 2026, with employment types broken down into 2% As Needed, 70% Full Time, 21% Part Time, and 7% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $34,822 per year, or $16.7 per hour.

Care Review Processor

Integrated Resources INC

El Paso, TX

Full-time

Re-posted 4 days ago

Job description

Job Description

Job Title: Care Review Processor

Duration: 4+ months contract

Location: Texas USA 79902

Hours: Mon- Fri 8:00 AM to 5:00 PM

Top Three Skill Sets: Customer Service, Computer Skills and medical terminology

Job Description:

  • Provide computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: Verify member eligibility and benefits, Determine provider contracting status and appropriateness, Determine diagnosis and treatment request Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), Determine COB status, Verify inpatient hospital census-admits and discharges, Perform action required per protocol using the appropriate Database.
  • Respond to requests for authorization of services submitted to CAM via phone, fax and mail according to Client's operational timeframes.
  • Participates in interdepartmental integration and collaboration to enhance the continuity of care for Client members including Behavioral Health and Long Term Care.
  • Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.
  • Provide excellent customer service for internal and external customers.
  • Meet department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores.
  • Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status.
  • Meet productivity standards.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

EDUCATION:

  • Accurate data entry at 40 WPM minimum.
  • Required Education: High School Diploma/GED
  • Required Experience: 1-4 years of experience in a Utilization Review Department in a Managed Care Environment.
  • Previous Hospital or Healthcare clerical, audit or billing experience. Experience with Medical Terminology
Additional Information

All your information will be kept confidential according to EEO guidelines.

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About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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