Care Review Processor I

Job Title: Care review Processor I
Duration: 3 Months
Location Remote in CA
Pay Rate: $25.03/hr. on W2

Job Description:
Need non-clinical support for Hospice SAI (new program).
Must work 8:30am – 5:30pm PST
Must live in California

Job Description:
Provide telephone, clerical and data entry support for the *** Services Care Management Team. Supports Care Management for all non-clinical functions.
Facilitates coordination of medical services to ensure the delivery of high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes for Client Members.
Responsible for initial review and triage of Care Management tasks.
Reviews data to identify principle member needs and works under the direction of the Case Manager to implement care plan.
Screens members using Client policies and processes assisting clinical Care Management staff as they identify appropriate medical services
Coordinates required services in accordance with member benefit plan.
Promotes communication, both internally and externally to enhance effectiveness of case management services (e.g., health care providers and health care team members). • Provides support services to case management team members by answering telephone calls, taking messages and researching information.
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
Protects the confidentiality of member information and adheres to company policies regarding confidentiality
May assist in the research and resolution of claims payment issues.

Must Have Skills:
Knowledge, Skills and Abilities that are necessary to perform the job Satisfactorily
Strong customer service skills to coordinate service delivery including attention to members/customers, sensitivity to concerns, proactive identification and resolution of issues to promote positive outcomes for members
Demonstrated ability to communicate, problem solve, and work effectively with people
Working knowledge of medical terminology and abbreviations
Ability to think analytically and to problem solve.
Good interpersonal/team skills
Must have a high regard for confidential information
Ability to work in a fast-paced environment
Able to work independently and as part of a team.
PC experience in Windows environment and accurate data entry at 40 WPM minimum. • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.

Day to Day Responsibilities:
Monitor email and fax queues for timely responses.
Answer telephone calls, take messages, schedule physician to physician conference calls for medical director reviews.
Collect and organize members’ medical records received from providers. Contact providers and request additional med records per Medical Director’s request.
Upload members’ medical records into the system for clinical reviews.
Attend daily team meetings
Complete all required trainings for compliance.
Assist with creation of authorizations.

Required Years of Experience:
Minimum 1 year experience. Managed Care experience is preferred.

Required Licensure / Education: High School Diploma or GED. Associate in arts degree is Preferred.