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Cvs Prior Authorization Remote Jobs in Silver Spring, MD

Global Alliant Inc

Clinical Analyst

Baltimore, MD · Remote

Remote Job Duration: Contract / FTE Client: Federal Criteria- Need US citizenship because of ... Utilization Management / Utilization Review / Prior Authorization * Clinical or healthcare ...

Global Alliant Inc

Clinical Analyst

Baltimore, MD · Remote

Remote JobDuration: Contract / FTE Client: Federal Criteria-Need US citizenshipbecause of federal ... Utilization Management / Utilization Review / Prior Authorization * Clinical or healthcare ...

USHP

Director Revenue Cycle Management

Rockville, MD · Remote

Remote Travel Required : As needed Who we are: US Health Partners ("USHP") seeks to redefine high ... Lead prior authorization program oversight, including workflow design, task management ...

New

MCKESSON

Field Reimbursement Manager

Arlington, VA · On-site +1

... remote interaction and on-site training. This position is client-facing and customer-facing and ... Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare ...

MCKESSON

Field Reimbursement Manager

Fairfax, VA · On-site +1

... remote interaction and on-site training. This position is client-facing and customer-facing and ... Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare ...

MCKESSON

Field Reimbursement Manager

Alexandria, VA · On-site +1

... remote interaction and on-site training. This position is client-facing and customer-facing and ... Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare ...

US Fertility, LLC

Financial Educator Remote

Annandale, VA · On-site +1

$23 - $27/hr

Opportunity Overview We have an immediate opening for an Financial Educator Remote to join our team ... Perform aspects of benefit verification and prior authorization * Provide ongoing financial ...

US Fertility

Financial Educator Remote

Annandale, VA · On-site +1

$23 - $27/hr

Opportunity Overview We have an immediate opening for an Financial Educator Remote to join our team ... Perform aspects of benefit verification and prior authorization * Provide ongoing financial ...

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Cvs Prior Authorization Remote information

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How much do cvs prior authorization remote jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for cvs prior authorization remote in Silver Spring, MD is $21.60, according to ZipRecruiter salary data. Most workers in this role earn between $17.88 and $23.85 per hour, depending on experience, location, and employer.

What is a CVS Prior Authorization remote?

A CVS Prior Authorization Remote job involves reviewing and processing medication prior authorization requests for CVS Health from a remote location. Employees in this role evaluate whether prescribed medications meet insurance requirements and communicate with healthcare providers or patients as needed. The job typically requires strong attention to detail, excellent communication skills, and a background in pharmacy or healthcare. Working remotely allows for flexibility while ensuring timely and accurate authorization decisions.

What are the primary responsibilities of a CVS Prior Authorization Specialist working remotely, and how do they collaborate with other healthcare professionals?

As a remote CVS Prior Authorization Specialist, your main duties involve reviewing and processing prior authorization requests for prescription medications, ensuring compliance with clinical guidelines and insurance requirements. You will regularly communicate with physicians, pharmacists, and insurance representatives to gather necessary information and clarify any discrepancies. Collaboration is typically conducted via secure digital platforms, phone, or email. The role requires strong attention to detail, timely decision-making, and the ability to work independently while maintaining high productivity standards in a virtual team environment.

What are the key skills and qualifications needed to thrive as a CVS Prior Authorization Specialist remote, and why are they important?

To thrive as a CVS Prior Authorization Specialist (Remote), you need a solid understanding of pharmacy benefits, insurance processes, and medical terminology, often supported by a pharmacy technician certification or relevant experience. Familiarity with prior authorization systems, electronic medical records (EMRs), and CVS-specific platforms is typically required. Strong attention to detail, excellent communication, and problem-solving abilities are crucial soft skills for efficiently handling patient and provider inquiries. These competencies are essential for ensuring accurate and timely medication approvals, which directly impact patient care and satisfaction.

What is the difference between Cvs Prior Authorization Remote vs Cvs Pharmacy Technician?

AspectCvs Prior Authorization RemoteCvs Pharmacy Technician
Required CredentialsCertification in healthcare or pharmacy-related fields, knowledge of insurance and prior authorization processesState pharmacy technician license, certification (e.g., PTCB), knowledge of pharmacy operations
Work EnvironmentRemote, administrative setting focused on insurance and authorization tasksIn-store or pharmacy setting, assisting pharmacists and customers
Employer & Industry UsageHealthcare and pharmacy companies, insurance providersRetail pharmacies, healthcare providers
Common Search & Comparison IntentUnderstanding remote administrative roles in pharmacyUnderstanding 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.

What are popular job titles related to Cvs Prior Authorization Remote jobs in Silver Spring, MD?

For Cvs Prior Authorization Remote jobs in Silver Spring, MD, the most frequently searched job titles are:

What job categories do people searching Cvs Prior Authorization Remote jobs in Silver Spring, MD look for?

The top searched job categories for Cvs Prior Authorization Remote jobs in Silver Spring, MD are:

What cities near Silver Spring, MD are hiring for Cvs Prior Authorization Remote jobs?

Cities near Silver Spring, MD with the most Cvs Prior Authorization Remote job openings:

Cvs Prior Authorization Remote jobs near you
Infographic showing various Cvs Prior Authorization Remote job openings in Silver Spring, MD as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $44,927 per year, or $21.6 per hour.

Lead Healthcare Product Owner

System One

Baltimore, MD • Remote

$72/hr

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 5 days ago

Job description

Lead Product Owner / Business Integration Lead (Prior Authorization) Location/Work model: 100% Remote (must work Eastern Time core hours) Type: Contract (~7 months, Possible extension) Compensation: $72/HR
About the role We’re looking for a Lead Product Owner / Business Integration Lead to stabilize and improve end-to-end Prior Authorization (PA) operations and the supporting technology/process integrations. This is a true hybrid role (Product Owner + Business Integration Lead) focused on fixing real breakdowns in the PA-to-claims flow—identifying failure points, driving corrective action, and delivering improvements that impact accuracy, turnaround time, and provider experience. This role is ideal for someone who has deep payer-side PA domain expertise and can confidently partner across clinical, IT, claims, and operations to drive solutions through to completion. Must-have systems/standards:
  • FACETS (including claims-to-operations “matching”)
  • GuidingCare (especially downstream workflow after the authorization leaves GuidingCare)
  • EDI 278
What you’ll do (Day-to-day)
  • Own end-to-end Prior Authorization (PA) program delivery across clinical, technical, and operational teams.
  • Lead requirements work: gather, document, validate, and manage functional/non-functional requirements, translating them into user stories and acceptance criteria.
  • Drive cross-functional execution across multiple workstreams: stakeholder workshops, design reviews, issue triage, and delivery planning.
  • Identify and resolve breakdowns/errors in the PA/claims process—pinpoint fail points and implement fixes/workarounds with clinical + IT teams.
  • Lead UAT planning and execution: test plans, defect documentation, coordination of fixes, and release readiness.
  • Track and improve PA performance metrics (e.g., turnaround time, denials, provider friction, auto-decision rates).
  • Support change communications/training and provide guidance to other analysts.
Must-Haves (Required) Domain / Experience
  • Deep end-to-end Prior Authorization expertise (not just general “healthcare IT”).
  • 15+ years in payer operations / healthcare delivery / utilization management / PA programs.
  • 8–10+ years operating as a Product Owner (or equivalent end-to-end product delivery lead) in a payer/healthcare environment.
  • Proven ability to lead large, cross-functional, multi-workstream initiatives and drive outcomes to closure.
  • Strong skills in requirements, stakeholder management, process/systems analysis, issue management, and executive-ready communication.
Systems / Workflow Knowledge (must be able to speak to the flow end-to-end)
  • FACETS: working knowledge of claims-to-operations “matching” and how PA/claims flow connects downstream (this is emphasized as critical).
  • GuidingCare: working knowledge, especially what happens after the authorization leaves GuidingCare.
  • EDI 278 experience/knowledge.
Nice-to-Haves (Preferred)
  • MBA (Bachelor’s required or equivalent additional relevant experience).
  • Prior experience helping drive a “task force” / stabilization effort where there are ongoing errors and high-visibility corrective actions.
Education
  • Bachelor’s degree in Business Administration/Management/Finance (or related) or equivalent experience
  • MBA preferred
Quick “Must-Have Keywords” (for screening/search) Prior Authorization (PA) | Utilization Management | Product Owner | Business Integration | FACETS | Claims matching | GuidingCare | EDI 278 | UAT | Requirements | User stories | Acceptance criteria

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1

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About System One

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System One helps employers get work done more efficiently and economically without compromising quality. Over our 35+ year history, we've helped connect thousands of talented people with innovative companies. The excitement of a perfect fit motivates us every single day.

Industry

Business consulting services and recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Pittsburgh, PA, US

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