Job Details

Care Review Processor (Remote)

Pay: $22.00 - $25.00/hour
Contract Length: 6 Months
Location: Fully Remote
Eligible States: Arizona (AZ), Washington (WA), Utah (UT), Texas (TX), New Mexico (NM), Idaho (ID), Iowa (IA)

Schedule

We are hiring multiple Care Review Processors with the following schedules:

• 1 Opening: Tuesday - Saturday, 9:00 AM - 6:00 PM PST
• 4 Openings: Monday - Friday, 9:00 AM - 6:00 PM PST

Position Overview

We are seeking detail-oriented Care Review Processors (CRPs) to support the Care Access and Monitoring (CAM) team. This role is responsible for reviewing and processing inpatient and prior authorization requests, verifying eligibility and benefits, entering and maintaining authorization records, and ensuring requests are routed appropriately for clinical review.

The ideal candidate will have prior experience with authorizations, utilization management, healthcare operations, or medical administration and thrive in a fast-paced environment where accuracy and compliance are critical.

Key Responsibilities

• Process inpatient and prior authorization requests received via phone, fax, mail, and electronic systems
• Load and maintain authorization records within internal systems
• Verify member eligibility, benefits, and coordination of benefits (COB) status
• Review authorization requests for completeness and obtain missing information from providers
• Determine provider network status and appropriateness
• Identify and assign relevant ICD-9, ICD-10, CPT, and HCPCS codes
• Verify hospital admissions, discharges, and inpatient census information
• Route cases requiring medical necessity review to clinical staff and Medical Directors
• Document case activity accurately and maintain complete records
• Manage work queues while meeting productivity, quality, and turnaround time expectations
• Respond to provider inquiries and deliver exceptional customer service
• Collaborate with nurses, case managers, Behavioral Health, and Long-Term Care teams to support continuity of care
• Ensure compliance with HIPAA, state, federal, and organizational guidelines

Required Qualifications

• High School Diploma or GED
• Experience loading and processing authorizations
• Strong data entry and computer skills
• Proficiency with Microsoft Office applications
• Knowledge of medical terminology and abbreviations
• Ability to manage confidential information with professionalism
• Strong communication, organizational, and problem-solving skills
• Ability to work independently and within a team environment
• Minimum typing speed of 40 WPM

Preferred Qualifications

• Prior Utilization Management (UM) or Utilization Review experience
• Managed Care experience
• Healthcare administrative, hospital clerical, medical billing, audit, or authorization experience
• Experience working with prior authorizations and healthcare benefit verification
• Familiarity with ICD-9, ICD-10, CPT, and HCPCS coding

What You'll Need

• Dedicated home workspace
• Reliable internet connection
• Ability to support a fully remote work environment
• Dual monitor and docking station setup (or single monitor with connecting cables)

Additional Information

• Fully remote opportunity
• Access to Protected Health Information (PHI) required
• Medicaid business line
• Potential for extension beyond the initial 6-month contract is currently unknown

Ideal Candidate

This position is well suited for candidates with experience in authorizations, utilization management, healthcare administration, medical records, referrals, managed care, or hospital operations who enjoy working in a fast-paced environment and are committed to delivering high-quality support to members and providers.

Apply today if you have authorization processing experience and are located in AZ, WA, UT, TX, NM, ID, or IA.