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Care Review Processor II (Remote – Temp to Perm)

Phoenix, AZ

Care Review Processor II (Remote – Temp to Perm)
Pay Rate: $22.00/hour
Start Date: April 28, 2025
Schedule: Monday – Friday, 8:30 AM – 5:30 PM PST
Location: Remote (must reside in one of the following states: AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater NYC), OH, TX, UT, WA (outside greater Seattle), WI)

A leading Managed Care Organization is seeking a Care Review Processor II to support their Care Access 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, temp-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 internal and external stakeholders.

  • Maintain confidentiality and adhere to HIPAA and company compliance standards.

Requirements:

  • High School Diploma or GED required.

  • 2-4 years of experience in a Utilization Review Department within a Managed Care setting.

  • Prior experience in a hospital, healthcare 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 Microsoft 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.


 

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