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Care Review Processor Molina Jobs (NOW HIRING)

Uloop Inc.

Care Review Clinician (RN)

Miami, FL · On-site

$60 - $80/hr

... for Molina and its members. * Processes requests within required timelines. * Refers appropriate ... At least 2 years of experience in hospital acute care, inpatient review, prior authorization ...

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Care Review Processor Molina information

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

As of Sep 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 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 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 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.

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 does a care review processor Molina do?

A care review processor at Molina reviews healthcare cases to determine the necessity and appropriateness of services covered by insurance. They analyze medical documentation, follow guidelines, and ensure compliance with policies, often using case management software. Strong attention to detail and knowledge of healthcare regulations are essential for this role.
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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, 70% Full Time, 21% Part Time, and 7% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $34,822 per year, or $16.7 per hour.

Care Review Clinician

Healthcare Support Staffing

Spokane, WA • On-site

Contractor

Re-posted 17 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Evaluates medical records and/or medical notes providing clinical expertise on coding accuracy.

Reviews for provider reconsideration requests related to claim edits and validation outcomes.

Utilizes established criteria for review of complex medical claims and refers to Chief Medical Officer or Medical Director for determinations when criteria are not met

Acting as a clinical resource, provides clinical review of claims to determine coding and billing accuracy and medical appropriateness of various types of provider claims. 

Reviews claims for correct billing and coding using Medicare Provider Manual guidelines. Documents clinical review summaries, bill audit findings and audit details in the data base. 

Identifies and reports quality of care issues to the Quality Management Department. 

Reports suspected member or provider fraud per Molina Healthcare Policy. 

Identifies and refers members with special needs to the appropriate Molina Healthcare program per policy/protocol. 

Participates in the development and implementation of proactive approaches to improve and standardize overall retrospective claims review. 


Qualifications

Candidate will provide clinical expertise in the application of medical and reimbursement policies within the claim adjudication process through claim review, medical record review and research. To provide expert knowledge in CMS, NCCI, AMA and other nationally published guidelines for correct coding and billing accuracy. 

Minimum 2-4 years of clinical practice.

Minimum 1 year utilization review or medical claim review experience

Active, unrestricted state nursing license in good standing

Preferred Experience in one of more of the following areas critical care, emergency medicine, surgical, pediatrics, advanced practice nursing, and billing and coding experience

Great organizational skills

Critical thinkers and the ability to make decisions using clinical background/knowledge

Able to work independently

Able to collaborate and work with peers to make decisions

Knowledge of state and federal regulations

In-depth Knowledge of ICD-9, CPT, and HCPTS

Great Verbal and Written Communication Skills because they will be interacting with Medical Directors       


Additional Information

If you are interested in applying to this position, please contact Brianne Salazar at (321)710-4799 and click the Green I'm Interested Button to email your resume.


Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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