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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 Clinician (RN) Remote (AZ)

Molina Healthcare

Long Beach, CA • On-site, Remote

$26.41 - $51.49/hr

Full-time

Posted 16 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 198 frontline employees who took The Breakroom Quiz

164th of 303 rated insurance

Job description


JOB DESCRIPTION
This position will support the Arizona state Plan. We are seeking a candidate with an Arizona RN licensure. The ideal candidate will have experience with UM and prior authorization with both inpatient and outpatient. Candidates with a Behavioral Health background are highly preferred. Further details to be discussed during our interview process. Prefers candidates with 3 years of experience.
Remote position, must reside in Arizona.
Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time with some weekends and holidays.
Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
• Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
• Processes requests within required timelines.
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
• Requests additional information from members or providers as needed.
• Makes appropriate referrals to other clinical programs.
• Collaborates with multidisciplinary teams to promote the Molina care model.
• Adheres to utilization management (UM) policies and procedures.
Required Qualifications
• At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
• Certified Professional in Healthcare Management (CPHM).
• Recent hospital experience in an intensive care unit (ICU) or emergency room.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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