Sacramento, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Long Beach, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Long Beach, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Fresno, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Fresno, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Francisco, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Francisco, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Bakersfield, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Bakersfield, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Sacramento, CA · Remote
$29 - $52/hr
Although this position is remote, applicants must be located in Pacific or Mountain Time Zones ... Function is responsible for utilization management which includes Prior Authorization Review of ...
Sacramento, CA · Remote
$29 - $52/hr
Although this position is remote, applicants must be located in Pacific or Mountain Time Zones ... Function is responsible for utilization management which includes Prior Authorization Review of ...
Sacramento, CA · On-site +1
$29 - $52/hr
Although this position is remote, applicants must be located in Pacific or Mountain Time Zones If ... Function is responsible for utilization management which includes Prior Authorization Review of ...
Sacramento, CA · On-site +1
$29 - $52/hr
Although this position is remote, applicants must be located in Pacific or Mountain Time Zones If ... Function is responsible for utilization management which includes Prior Authorization Review of ...
$150K - $165K/yr
In this fully remote position, you'll use your clinical judgment to review claims and prior authorizations, helping ensure members receive the right care at the right time. Your work directly ...
$150K - $165K/yr
In this fully remote position, you'll use your clinical judgment to review claims and prior authorizations, helping ensure members receive the right care at the right time. Your work directly ...
Perform clinical reviews of dental claims and prior authorization requests across all lines of ... Remote or hybrid work options available for various positions. Compensation In the spirit of pay ...
Perform clinical reviews of dental claims and prior authorization requests across all lines of ... Remote or hybrid work options available for various positions. Compensation In the spirit of pay ...
West Sacramento, CA · On-site +1
$70K - $100K/yr
Experience with medical review, utilization review, medical necessity review, prior authorization ... Remote work environment. * Monday through Friday work schedule. * Work primarily from your home ...
West Sacramento, CA · On-site +1
$70K - $100K/yr
Experience with medical review, utilization review, medical necessity review, prior authorization ... Remote work environment. * Monday through Friday work schedule. * Work primarily from your home ...
Los Angeles, CA · Remote
$35 - $42/hr
Prior experience in home infusion. * Preferred: Familiarity with HCPCS and ICD-10 coding ... Opportunity for remote work based on qualifications. * Competitive salary, negotiable based on ...
Quick apply
Los Angeles, CA · Remote
$35 - $42/hr
Prior experience in home infusion. * Preferred: Familiarity with HCPCS and ICD-10 coding ... Opportunity for remote work based on qualifications. * Competitive salary, negotiable based on ...
West Sacramento, CA · Remote
$70K - $100K/yr
Experience with medical review, utilization review, medical necessity review, prior authorization ... Remote work environment. * Monday through Friday work schedule. * Work primarily from your home ...
West Sacramento, CA · Remote
$70K - $100K/yr
Experience with medical review, utilization review, medical necessity review, prior authorization ... Remote work environment. * Monday through Friday work schedule. * Work primarily from your home ...
West Sacramento, CA · Remote
$70K - $100K/yr
Experience with medical review, utilization review, medical necessity review, prior authorization ... Remote work environment. * Monday through Friday work schedule. * Work primarily from your home ...
West Sacramento, CA · Remote
$70K - $100K/yr
Experience with medical review, utilization review, medical necessity review, prior authorization ... Remote work environment. * Monday through Friday work schedule. * Work primarily from your home ...
| Aspect | Cvs Prior Authorization Remote | Cvs Pharmacy Technician |
|---|---|---|
| Required Credentials | Certification in healthcare or pharmacy-related fields, knowledge of insurance and prior authorization processes | State pharmacy technician license, certification (e.g., PTCB), knowledge of pharmacy operations |
| Work Environment | Remote, administrative setting focused on insurance and authorization tasks | In-store or pharmacy setting, assisting pharmacists and customers |
| Employer & Industry Usage | Healthcare and pharmacy companies, insurance providers | Retail pharmacies, healthcare providers |
| Common Search & Comparison Intent | Understanding remote administrative roles in pharmacy | Understanding pharmacy technician roles and responsibilities |
While Cvs Prior Authorization Remote involves handling insurance approvals remotely, Cvs Pharmacy Technicians work directly in pharmacies assisting with medication dispensing. Both roles require pharmacy-related knowledge but differ in work environment and specific credentials.
The most popular types of Cvs Prior Authorization jobs in California are:
For Cvs Prior Authorization Remote jobs in California, the most frequently searched job titles are:
The top searched job categories for Cvs Prior Authorization Remote jobs in California are:
Cities in California with the most Cvs Prior Authorization Remote job openings:
Sacramento, CA • Remote
$30.37 - $59.21/hr
Full-time
Re-posted yesterday
8.0
Based on 199 frontline employees who took The Breakroom Quiz
171st of 315 rated insurance
JOB DESCRIPTION Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.
Required Qualifications
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Certified Professional in Healthcare Management (CPHM).
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
