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Director Insurance Prior Authorization Jobs in California

MedImpact

Prior Authorization Coordinator I

San Diego, CA · On-site

$19.75 - $24.50/hr

Collaborates with MCO and Self-Insured client teams to understand PBM clients' prior authorization processing requirements and expectations. As appropriate for experience and career path level ...

OPN Healthcare

Be Seen First

Prior Authorization & Referral Coordinator

Glendale, CA · On-site

$18 - $22/hr

Insurance Verification: Determine the need for prior authorization based on insurance guidelines and verify patient eligibility. * Medical Records Review: Compile necessary medical documentation for ...

Akido

Clinical Review Nurse - Prior Authorization

Chino, CA · On-site

$62K - $93K/yr

The Clinical Review Nurse works closely with providers, Medical Directors, and operational teams to ... Review and process prior authorizations for outpatient services, procedures, diagnostic testing ...

Akido

Clinical Review Nurse - Prior Authorization

Chino, CA · On-site

$62K - $93K/yr

The Clinical Review Nurse works closely with providers, Medical Directors, and operational teams to ... Review and process prior authorizations for outpatient services, procedures, diagnostic testing ...

Akido

Clinical Review Nurse - Prior Authorization

Chino, CA · On-site

$62K - $93K/yr

The Clinical Review Nurse works closely with providers, Medical Directors, and operational teams to ... Review and process prior authorizations for outpatient services, procedures, diagnostic testing ...

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All JobsInsurance Prior Authorization JobsDirector Insurance Prior Authorization JobsDirector Insurance Prior Authorization Jobs in California

Director Insurance Prior Authorization information

What does a director insurance prior authorization do?

A Director of Insurance Prior Authorization oversees the processes required to obtain insurance approvals for medical procedures, prescriptions, or treatments. They manage teams responsible for submitting prior authorization requests and ensure compliance with insurance guidelines and regulations. Their role includes improving workflow efficiency, reducing denials, and collaborating with healthcare providers and insurance companies. Additionally, they analyze trends to optimize the authorization process and provide training to staff on policy changes.

What are the key skills and qualifications needed to thrive as a director insurance prior authorization?

To thrive as a Director of Insurance Prior Authorization, you need expertise in healthcare administration, insurance processes, and regulatory compliance, typically supported by a bachelor's or master's degree in healthcare or business administration. Familiarity with prior authorization software, electronic health records (EHRs), and payer systems is crucial for overseeing efficient authorization workflows. Strong leadership, problem-solving, and communication skills help drive team performance and manage complex stakeholder relationships. These skills ensure timely approvals, reduce claim denials, and maintain regulatory compliance, which directly impact patient access and organizational revenue.

What are some common challenges faced by a director insurance prior authorization, and how can they be effectively managed?

A Director of Insurance Prior Authorization often encounters challenges such as navigating constantly changing insurance requirements, ensuring timely approvals for patient care, and managing high volumes of authorization requests. Effective management involves staying updated on payer policies, implementing robust tracking systems, and fostering strong communication between clinical, administrative, and payer teams. Building a knowledgeable team and utilizing technology to streamline workflows can also help reduce denials and improve turnaround times.

What is the difference between Director Insurance Prior Authorization vs Insurance Authorization Specialist?

AspectDirector Insurance Prior AuthorizationInsurance Authorization Specialist
CredentialsBachelor's degree, industry certifications often preferredHigh school diploma or equivalent, relevant certifications beneficial
Work EnvironmentManagement level, overseeing teams and processesOperational role, performing authorization tasks
Employer & Industry UsageHospitals, insurance companies, healthcare organizationsMedical offices, insurance companies, healthcare providers
Primary ResponsibilitiesOverseeing authorization processes, policy compliance, team managementProcessing authorization requests, verifying coverage, documentation

The main difference is that the Director Insurance Prior Authorization manages teams and oversees authorization policies, while the Insurance Authorization Specialist handles the day-to-day processing of authorization requests. Both roles require knowledge of insurance policies, but the director position involves leadership and strategic oversight.

What are the most commonly searched types of Insurance Prior Authorization jobs in California?

The most popular types of Insurance Prior Authorization jobs in California are:

What are popular job titles related to Director Insurance Prior Authorization jobs in California?

For Director Insurance Prior Authorization jobs in California, the most frequently searched job titles are:

What job categories do people searching Director Insurance Prior Authorization jobs in California look for?

The top searched job categories for Director Insurance Prior Authorization jobs in California are:

What cities in California are hiring for Director Insurance Prior Authorization jobs?

Cities in California with the most Director Insurance Prior Authorization job openings:

Director Insurance Prior Authorization jobs near you
Infographic showing various Director Insurance Prior Authorization job openings in California as of August 2026, with employment types broken down into 85% Full Time, 12% Part Time, and 3% Contract. Highlights an 90% In-person, 2% Hybrid, and 8% Remote job distribution.

Prior Authorization Specialist

Infusion4Health Inc

Brea, CA • On-site

$23 - $27/hr

Full-time

Re-posted 29 days ago

Job description

Prior Authorization Specialist
Job Description

Infusion for Health is a referral-based infusion center that services all providers in multiple locations in California, Arizona, Nevada, Washington, Colorado, and Missouri. Our center is unique and offers individual comfortable private rooms for our patients. Our mission is to provide exceptional service in the administration of infusion therapy in a comfortable, patient-focused environment by providing exemplary professional clinical care.

Our company is continuing to grow and we're looking to add a Prior Authorization Specialist to support our patient care operations department.

This is a full-time, 5 days a week position, onsite at our Brea HQ office.

Compensation: $23-$27/hr DOE + Benefits

Key Responsibilities:

  • Responsible for ensuring timely, accurate submission follow-up and approval of Authorizations. Work with urgency, high-quality and high communication with patients, insurance and additional stakeholders as needed.
  • Review the accuracy and completeness of the information requested and ensure that all supporting documents are present
  • Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
  • Collaborate with other departments to assist in obtaining prior authorizations/appeals
  • Document all interactions with insurance companies or other stakeholders within the company system
  • Document all prior authorization information, including approval dates, billing units, procedure codes, and prior authorization number in the patient profile
  • Proactively work on prior authorizations that are due to be expired
  • Conduct job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
  • Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership.
  • Other duties as assigned

Education and/or Experience Needed:

  • At least 2 years experience in infusion or pharmacy prior authorization is required
  • At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines
  • Ability to effectively handle multiple priorities within a changing environment, emphasizing paperless workflow
  • Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.
  • Intermediate level skills in Microsoft Excel & Word

Monday to Friday
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