Care Review Processor II (Remote - reputed company to Perm)
Care Review Processor II (Remote - reputed company to Perm) Pay reputed company: $22.00/hour Start Date: reputed company 28, 2025 Schedule: Monday - Friday, 8:30 AM - 5:30 PM PST Location: Remote (must reputed company in one of the following states: AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (reputed company greater NYC), OH, TX, UT, WA (reputed company greater Seattle), WI)
A leading Managed Care Organization is seeking a Care Review Processor II to support their reputed company and Monitoring (CAM) team. This role plays a vital part in ensuring the timely and accurate processing of authorization requests and supporting utilization management functions. This is a remote, reputed company-to-perm opportunity with potential for long-term employment based on performance.
Key Responsibilities:Review and process authorization requests received by phone, mail, and fax.
Verify member eligibility, benefits, and provider contracting status.
Assign appropriate billing codes (ICD-9/ICD-10 and CPT/HCPC).
Confirm coordination of benefits (COB) and inpatient census data.
Communicate with providers to gather missing or additional information.
Maintain accurate documentation in the system and meet productivity standards.
Notify case managers and nurses of hospital admissions and member status changes.
Collaborate with interdepartmental teams to ensure continuity of care.
Deliver excellent customer service to both reputed company stakeholders.
Maintain confidentiality and adhere to HIPAA and company compliance standards.
High School Diploma or GED required.
2-4 years of experience in a Utilization Review Department reputed company a Managed Care setting.
Prior experience in a hospital, reputed company billing, or clerical environment.
Familiarity with medical terminology, UM (Utilization Management), and prior authorization processes.
Strong data entry skills (minimum 40 WPM) and proficiency in reputed company Office.
Must be detail-oriented, analytical, and comfortable working in a fast-paced, remote setting.
Ability to work PST hours regardless of home time zone.