Jacksonville, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Jacksonville, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Tampa, FL · Remote
$26.41 - $43/hr
Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Tampa, FL · Remote
$26.41 - $43/hr
Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Orlando, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Orlando, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Saint Petersburg, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Saint Petersburg, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Orlando, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Orlando, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
$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 ...
$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 ...
Tampa, FL · On-site
$29 - $30/hr
... Care Reviews. Recommend actions that may increase quality /productivity related to the review process. Communicates the current status of workload and availability for additional assignments ...
Tampa, FL · On-site
$29 - $30/hr
... Care Reviews. Recommend actions that may increase quality /productivity related to the review process. Communicates the current status of workload and availability for additional assignments ...
Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
$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 ...
$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 ...
$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 ...
$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 ...
Saint Petersburg, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Saint Petersburg, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Saint Petersburg, FL · Remote
$26.41 - $43/hr
Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Saint Petersburg, FL · Remote
$26.41 - $43/hr
Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Orlando, FL · Remote
$26.41 - $43/hr
Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Orlando, FL · Remote
$26.41 - $43/hr
Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Miami Beach, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Miami Beach, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Miami Beach, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Miami Beach, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Jacksonville, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Jacksonville, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Fort Lauderdale, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Fort Lauderdale, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Long Beach, CA · On-site +1
$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 ...
Long Beach, CA · On-site +1
$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 ...
Tampa, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Tampa, FL · Remote
$26.41 - $43/hr
... processes. Responsible for verifying that services are medically necessary and align with ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Long Beach, CA · Remote
$26.41 - $43/hr
Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
Long Beach, CA · Remote
$26.41 - $43/hr
Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ... acute care, inpatient review, prior authorization, managed care, or equivalent combination of ...
$8.89 - $10.45
6% of jobs
$10.45 - $12
6% of jobs
$13.34 is the 25th percentile. Wages below this are outliers.
$12 - $13.55
14% of jobs
$13.55 - $15.10
19% of jobs
The median wage is $15.49 / hr.
$15.10 - $16.65
15% of jobs
$16.65 - $18.20
13% of jobs
$18.35 is the 75th percentile. Wages above this are outliers.
$18.20 - $19.76
9% of jobs
$19.76 - $21.31
5% of jobs
$21.31 - $22.86
5% of jobs
$22.86 - $24.41
3% of jobs
$24.41 - $25.96
3% of jobs
$8
$16
$25
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.
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 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.
$26.41 - $43/hr
Full-time
Re-posted 13 days ago
8.1
Based on 193 frontline employees who took The Breakroom Quiz
134th of 281 rated insurance
JOB DESCRIPTION
Must reside in Florida
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.
#PJHS3
#LI-AC1
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 - $43 / 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
