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Anthem Utilization Review Jobs in California (NOW HIRING)

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Case Manager

Fresno, CA · On-site

$21 - $27.25/hr

Complete Utilization Reviews as directed by supervisor * Drives clients as needed to appointments ... Anthem Blue Cross Anthem PPO Silver 45/40 1,750 Ded Anthem Blue Cross Anthem PPO Gold 30/20 500 Ded ...

AMFM Healthcare

Adolescent Primary Therapist

Bonsall, CA · On-site

$72K - $96K/yr

Collaborate with the utilization review team to provide pre-certification and concurrent reviews ... Medical, Dental, and Vision plans through Anthem or Kaiser. * FSA/HSA Accounts. * Life/AD&D ...

AMFM Healthcare

Adolescent Primary Therapist

Bonsall, CA · On-site

$72K - $96K/yr

Collaborate with the utilization review team to provide pre-certification and concurrent reviews ... Medical, Dental, and Vision plans through Anthem or Kaiser. * FSA/HSA Accounts. * Life/AD&D ...

AMFM Healthcare

Adolescent Primary Therapist

Bonsall, CA · On-site

$72K - $96K/yr

Collaborate with the utilization review team to provide pre-certification and concurrent reviews ... Medical, Dental, and Vision plans through Anthem or Kaiser. * FSA/HSA Accounts. * Life/AD&D ...

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Anthem Utilization Review information

What is an Anthem Utilization Review?

An Anthem Utilization Review job involves assessing medical services and treatments to ensure they are necessary, cost-effective, and aligned with insurance policies. Professionals in this role review patient records, apply clinical guidelines, and collaborate with healthcare providers to determine coverage eligibility. They help prevent unnecessary procedures while supporting quality patient care. This position typically requires a healthcare background, such as nursing or case management, along with knowledge of insurance regulations and medical necessity criteria.

What does an Anthem Utilization Review do?

A typical day in an Anthem Utilization Review position involves evaluating medical records and authorization requests to determine if healthcare services meet established criteria for coverage. You’ll collaborate frequently with healthcare providers, case managers, and internal teams to clarify clinical information and help guide appropriate care pathways. The job is largely desk-based and requires strong organizational skills to manage multiple concurrent cases and meet tight deadlines. Most professionals in this role work within a team structure, sharing best practices and supporting each other in making objective, evidence-based decisions. This dynamic environment offers exposure to a variety of healthcare scenarios and opportunities for ongoing learning in utilization management.

What are the key skills and qualifications needed to thrive in an Anthem Utilization Review?

To thrive as an Anthem Utilization Review professional, you need a background in nursing or healthcare, strong analytical abilities, and familiarity with medical terminology and insurance guidelines. Experience with clinical documentation systems, review software, and URAC or NCQA certifications are commonly required. Excellent communication, critical thinking, and attention to detail are crucial soft skills in this position. These capabilities ensure accurate review of medical necessity, effective collaboration with providers, and regulatory compliance, which are vital for quality patient outcomes and cost management.

What are the most commonly searched types of Anthem Utilization Review jobs in California?

The most popular types of Anthem Utilization Review jobs in California are:

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For Anthem Utilization Review jobs in California, the most frequently searched job titles are:

What job categories do people searching Anthem Utilization Review jobs in California look for?

The top searched job categories for Anthem Utilization Review jobs in California are:

What cities in California are hiring for Anthem Utilization Review jobs?

Cities in California with the most Anthem Utilization Review job openings:

Anthem Utilization Review jobs near you
Infographic showing various Anthem Utilization Review job openings in California as of August 2026, with employment types broken down into 2% As Needed, 88% Full Time, 3% Part Time, and 7% Contract. Highlights an 88% In-person, 2% Hybrid, and 10% Remote job distribution.

Prior Authorization Pharmacy Technician

Healthcare Support Staffing

Glen Ellen, CA

$19.75 - $24/hr

Full-time

Medical, Dental, Vision

Re-posted 10 days ago

Job description

Company Description

Anthem, Inc. is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With more than 73 million people served by its affiliated companies including nearly 40 million enrolled in its family of health plans, Anthem is one of the nation's leading health benefits companies.

One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.
We offer a broad range of medical and specialty products.

Job Description

Candidate will be working in the MagellanRX call center and will be responsible for answering around 30-50 calls per day (majority being inbound). Calls may be from enrollees, doctor offices or pharmacies and topics can include Prescription Approvals, Intiail/Prior Authorization, Claims, ID Cards, DUR (Drug Utilization Review) rejection, etc.

 Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers.

 Essential Functions:

  • Determines appropriateness for medications.
  • Communicates decision to physicians, physician's office staff, medical management staff and/or pharmacists.
  • Researches, resolves and documents prior authorization outcomes in pharmacy system.
  • Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician's office staff, medical management staff and/or pharmacists.
  • Escalates requests to Pharmacist when request requires extensive clinical review or denial.
  • Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management
  • Performs other duties as required
Qualifications
  • Must have either a Pharm Tech Certification(CPT) in the state of VA or have the PTCB (national certification)
  • At least 6 months of dispensing or retail experience (equivalent internal training will be substituted)
  • Previous reimbursement experience and/or working in a health plan/healthcare setting
  • In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary (preferred drug list) management techniques (ability to objectively discriminate between superior and marginal medications), medical terminology and/or current diagnostic/reimbursement clinical criteria
  • Knowledge of prior auth
  • Ability to identify and trouble-shoot problematic issues
  • Proficiency in Pharmacy computerized systems and software applications and MS Office Product Suite
Additional Information

Advantages of this Opportunity:

Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
Monday through Friday 8am-5pm


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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