Phoenix, AZ · Remote
$26.41 - $51.49/hr
Further details to be discussed during our interview process. Prefers candidates with 3 years of ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Phoenix, AZ · Remote
$26.41 - $51.49/hr
Further details to be discussed during our interview process. Prefers candidates with 3 years of ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Tuba City, AZ · On-site
Demonstrated knowledge of Utilization Review, Case Management, and Purchased Referred Care (PRC) processes. * Proficiency with Electronic Health Record (EHR) systems. About the Organization ...
New
Quick apply
Tuba City, AZ · On-site
Demonstrated knowledge of Utilization Review, Case Management, and Purchased Referred Care (PRC) processes. * Proficiency with Electronic Health Record (EHR) systems. About the Organization ...
New
... care, medical necessity determinations, and overall utilization management processes based on ... Review members' transfer and discharge plans to promote continuity of care and minimize gaps ...
New
... care, medical necessity determinations, and overall utilization management processes based on ... Review members' transfer and discharge plans to promote continuity of care and minimize gaps ...
New
Tempe, AZ · Remote
$35 - $45.94/hr
You will perform frequent case reviews, check medical records and speak with care providers ... Any Oscar applicant who requires reasonable accommodations during the application process should ...
Quick apply
Tempe, AZ · Remote
$35 - $45.94/hr
You will perform frequent case reviews, check medical records and speak with care providers ... Any Oscar applicant who requires reasonable accommodations during the application process should ...
Tuba City, AZ · On-site
... care and utilization review processes. Demonstrate knowledge of electronic health record systems.
Tuba City, AZ · On-site
... care and utilization review processes. Demonstrate knowledge of electronic health record systems.
Knowledge of case management, purchased/referred care, and utilization review processes . * Experience with electronic health record systems . 298653 No Local candidates at this time. About Bestica ...
Knowledge of case management, purchased/referred care, and utilization review processes . * Experience with electronic health record systems . 298653 No Local candidates at this time. About Bestica ...
Tucson, AZ · On-site +1
$24.77/hr
JOB TITLE: Program Specialist III Foster Care Review Board JOB #: 2691 DIVISION: Dependent ... Travel level: up to 10%. SELECTION PROCESS: Applicants must be currently authorized to work in the ...
Tucson, AZ · On-site +1
$24.77/hr
JOB TITLE: Program Specialist III Foster Care Review Board JOB #: 2691 DIVISION: Dependent ... Travel level: up to 10%. SELECTION PROCESS: Applicants must be currently authorized to work in the ...
Tucson, AZ · On-site +1
$24.77/hr
JOB TITLE: Program Specialist III Foster Care Review Board JOB #: 2691 DIVISION: Dependent ... Travel level: up to 10%. SELECTION PROCESS: Applicants must be currently authorized to work in the ...
Tucson, AZ · On-site +1
$24.77/hr
JOB TITLE: Program Specialist III Foster Care Review Board JOB #: 2691 DIVISION: Dependent ... Travel level: up to 10%. SELECTION PROCESS: Applicants must be currently authorized to work in the ...
Tuba City, AZ · On-site
$2.6K/wk
... care, and utilization review processes - Knowledge of electronic health record systems Description: The Utilization Review Nurse ensures that patients receive appropriate care by verifying medical ...
Tuba City, AZ · On-site
$2.6K/wk
... care, and utilization review processes - Knowledge of electronic health record systems Description: The Utilization Review Nurse ensures that patients receive appropriate care by verifying medical ...
None. Who is Axiom Care? Founded in 2012, Axiom Care is a Phoenix-based behavioral health ... Analytical Thinking - Uses logical reasoning to process, break down, and work through a situation ...
None. Who is Axiom Care? Founded in 2012, Axiom Care is a Phoenix-based behavioral health ... Analytical Thinking - Uses logical reasoning to process, break down, and work through a situation ...
None. Who is Axiom Care? Founded in 2012, Axiom Care is a Phoenix-based behavioral health ... Analytical Thinking - Uses logical reasoning to process, break down, and work through a situation ...
None. Who is Axiom Care? Founded in 2012, Axiom Care is a Phoenix-based behavioral health ... Analytical Thinking - Uses logical reasoning to process, break down, and work through a situation ...
Tuba City, AZ · On-site
$2.6K/wk
Knowledge of case management, purchased/referred care, and utilization review processes . * Experience with electronic health record systems . 298653 No Local candidates at this time. About Bestica ...
Tuba City, AZ · On-site
$2.6K/wk
Knowledge of case management, purchased/referred care, and utilization review processes . * Experience with electronic health record systems . 298653 No Local candidates at this time. About Bestica ...
Tempe, AZ · On-site
$18/hr
Why join Customer Care? Your Launchpad to a Carvana Career: We believe in a "Careers Not Jobs ... Review, process, and complete documentation required to transfer a vehicle title, ensuring all ...
Tempe, AZ · On-site
$18/hr
Why join Customer Care? Your Launchpad to a Carvana Career: We believe in a "Careers Not Jobs ... Review, process, and complete documentation required to transfer a vehicle title, ensuring all ...
Why join Customer Care? Your Launchpad to a Carvana Career: We believe in a "Careers Not Jobs ... Review, process, and complete documentation required to transfer a vehicle title, ensuring all ...
Why join Customer Care? Your Launchpad to a Carvana Career: We believe in a "Careers Not Jobs ... Review, process, and complete documentation required to transfer a vehicle title, ensuring all ...
Tuba City, AZ · On-site
$2.6K/wk
... care and utilization review processes. · Demonstrate knowledge of electronic health record systems. Shift Information: Monday - Friday from 8am - 5pm. Callback on weekends/holiday About Bestica We ...
Tuba City, AZ · On-site
$2.6K/wk
... care and utilization review processes. · Demonstrate knowledge of electronic health record systems. Shift Information: Monday - Friday from 8am - 5pm. Callback on weekends/holiday About Bestica We ...
Tuba City, AZ · On-site
$2.6K/wk
... review processes Express Healthcare Staffing Colorado Job ID #CO---1655. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be ...
Tuba City, AZ · On-site
$2.6K/wk
... review processes Express Healthcare Staffing Colorado Job ID #CO---1655. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be ...
Must demonstrate knowledge of case management, purchased referred care and utilization review processes. * Must demonstrate knowledge of electronic health record systems. * A valid, current, full and ...
Quick apply
Must demonstrate knowledge of case management, purchased referred care and utilization review processes. * Must demonstrate knowledge of electronic health record systems. * A valid, current, full and ...
$24 - $29/hr
... Health Care Cost Containment System) requirements. The ideal candidate thrives in a fast-paced ... Coordinate and complete utilization review processes in compliance with AHCCCS guidelines and ...
$24 - $29/hr
... Health Care Cost Containment System) requirements. The ideal candidate thrives in a fast-paced ... Coordinate and complete utilization review processes in compliance with AHCCCS guidelines and ...
Phoenix, AZ · On-site
$24 - $29/hr
... Health Care Cost Containment System) requirements. The ideal candidate thrives in a fast-paced ... Coordinate and complete utilization review processes in compliance with AHCCCS guidelines and ...
Phoenix, AZ · On-site
$24 - $29/hr
... Health Care Cost Containment System) requirements. The ideal candidate thrives in a fast-paced ... Coordinate and complete utilization review processes in compliance with AHCCCS guidelines and ...
Tuba City, AZ · On-site
$2.5K - $2.6K/wk
... direct care - Knowledge: Familiarity with case management, utilization review processes, and ... electronic health record systems - Ability: Capable of functioning effectively in an inpatient ...
Tuba City, AZ · On-site
$2.5K - $2.6K/wk
... direct care - Knowledge: Familiarity with case management, utilization review processes, and ... electronic health record systems - Ability: Capable of functioning effectively in an inpatient ...
$8.29 - $9.73
6% of jobs
$9.73 - $11.18
6% of jobs
$12.43 is the 25th percentile. Wages below this are outliers.
$11.18 - $12.63
14% of jobs
$12.63 - $14.07
19% of jobs
The median wage is $14.43 / hr.
$14.07 - $15.52
15% of jobs
$15.52 - $16.96
13% of jobs
$17.10 is the 75th percentile. Wages above this are outliers.
$16.96 - $18.41
9% of jobs
$18.41 - $19.86
5% of jobs
$19.86 - $21.30
5% of jobs
$21.30 - $22.75
3% of jobs
$22.75 - $24.19
3% of jobs
$8
$15
$24
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.
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.
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.
For Care Review Processor jobs in Arizona, the most frequently searched job titles are:
The top searched job categories for Care Review Processor jobs in Arizona are:
$26.41 - $51.49/hr
Full-time
This job post has expired today. Applications are no longer accepted.
8.0
Based on 199 frontline employees who took The Breakroom Quiz
167th of 311 rated insurance
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
Pay Range: $26.41 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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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.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
