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Job Requirements of Care Review Processor I:
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Employment Type:
Contractor
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Location:
Phoenix, AZ (Onsite)
Do you meet the requirements for this job?
Care Review Processor I
Careers Integrated Resources Inc
Phoenix, AZ (Onsite)
Contractor
Job Title: Care Review Processor I
Job Location: Phoenix, AZ
Job Duration: 12-13 Months (possibility of extension)
Shift: 8:30am – 5:30pm PST
Job Summary:
Job Location: Phoenix, AZ
Job Duration: 12-13 Months (possibility of extension)
Shift: 8:30am – 5:30pm PST
Job Summary:
- Provide telephone, clerical and data entry support for the Client 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.
- 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.
- High School Diploma or GED.
- Associate in arts degree is Preferred.
- Minimum 1 year experience.
- Managed Care experience is preferred.
- 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
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