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Care Review Processor Molina Jobs (NOW HIRING)

Molina Healthcare

Care Review Clinician (RN)

Tampa, FL

$26.41 - $51.49/hr

... Molina and its members. Processes requests within required timelines. Refers appropriate cases to ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...

Molina Healthcare

Care Review Clinician (RN)

Orlando, FL · On-site

$26.41 - $51.49/hr

... for Molina and its members. • Processes requests within required timelines. • Refers ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...

Molina Healthcare

Care Review Clinician (RN)

Bothell, WA

$26.41 - $59.21/hr

... Molina and its members. Processes requests within required timelines. Refers appropriate cases to ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...

Molina Healthcare

Care Review Clinician (RN)

Miami, FL · On-site

$26.41 - $51.49/hr

... for Molina and its members. • Processes requests within required timelines. • Refers ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...

Molina Healthcare

Care Review Clinician (RN)

Orlando, FL

$26.41 - $51.49/hr

... Molina and its members. Processes requests within required timelines. Refers appropriate cases to ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...

Molina Healthcare

Care Review Clinician, ABA

Miami, FL · On-site

$26.41 - $51.49/hr

Must live in Florida Job Summary Provides support for member clinical review processes specific to ... Participates in interdepartmental integration and collaboration to enhance care of Molina members ...

Molina Healthcare

Care Review Clinician (RN)

Miami, FL

$26.41 - $51.49/hr

... Molina and its members. Processes requests within required timelines. Refers appropriate cases to ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...

Molina Healthcare

Care Review Clinician, ABA

Orlando, FL

$26.41 - $51.49/hr

Job Summary Provides support for member clinical review processes specific to applied behavioral ... Participates in interdepartmental integration and collaboration to enhance care of Molina members ...

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How much do care review processor molina jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for care review processor molina 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 is the difference between Care Review Processor Molina vs Care Coordinator Molina?

AspectCare Review Processor MolinaCare Coordinator Molina
CredentialsTypically requires high school diploma or equivalent; some roles may prefer healthcare-related certificationsRequires similar credentials; often a healthcare or social services background
Work EnvironmentOffice setting, reviewing patient files and insurance claimsOffice or community setting, coordinating patient care and services
Employer & IndustryHealth insurance companies, healthcare providersHealthcare organizations, insurance companies

Care Review Processors focus on reviewing insurance claims and documentation, while Care Coordinators actively manage patient care plans. Both roles require healthcare knowledge and work in similar environments, but their responsibilities differ in scope and daily tasks.

What are the key skills and qualifications needed to thrive as a care review processor at Molina?

To thrive as a Care Review Processor at Molina, you need a strong knowledge of healthcare terminology, medical coding, and case review procedures, typically supported by experience in healthcare administration or a related field. Familiarity with claims processing systems, electronic health records (EHR), and utilization management software is often required. Attention to detail, organizational skills, and effective communication are critical soft skills for accurately reviewing and documenting care decisions. These competencies ensure timely, compliant, and accurate processing of care reviews, which supports patient care quality and organizational efficiency.

What is a care review processor at Molina?

Care Review Processors at Molina are professionals responsible for reviewing and processing healthcare service requests to ensure they meet medical necessity and policy guidelines. They work closely with clinicians, members, and providers to gather necessary documentation and help determine if requested services are covered under a member’s health plan. Their work supports timely and accurate decision-making for authorizations and appeals, helping ensure members receive appropriate care. Typically, this role requires attention to detail, familiarity with medical terminology, and the ability to navigate health plan systems.

What are some common challenges faced by care review processors at Molina, and how can applicants prepare to handle them?

Care Review Processors at Molina often navigate complex medical documentation and must ensure timely, accurate evaluations of care requests. Common challenges include managing a high volume of cases while meeting strict regulatory timelines and maintaining clear communication with providers and internal teams. Applicants can prepare by familiarizing themselves with medical terminology, developing strong organizational skills, and staying current with healthcare compliance standards. Proactive time management and attention to detail are key to success in this fast-paced environment.
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Care Review Processor Molina jobs near you
Infographic showing various Care Review Processor Molina job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 69% Full Time, 22% 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 • On-site

Full-time

Re-posted 7 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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