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Full Time Optum Prior Authorization Jobs (NOW HIRING)

CareMed Specialty Pharmacy

$23 - $25/hr

Pharmacy Prior Authorization Specialist - CareMed Specialty Pharmacy Buffalo, NY | Full-Time | Starting at $23.00/hr and up Sign-On Bonus: $5,000 for employees starting before July 31, 2026. Join a ...

Soleo Health, Inc.

$20 - $23/hr

Job Type Full-time Description Soleo Health is seeking a Prior Authorization Coordinator to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care!

BlinkRx

Prior Authorization Specialist

Pittsburgh, PA

$17.50 - $23.25/hr

Onsite full time position in Pittsburgh (Robinson Township) Responsibilities: * Assist in the initiation of new prior authorization requests to providers * Identify the correct prior authorization ...

MC-Rx

Prior Authorization Coordinator

Miramar, FL · On-site

$21 - $23/hr

Manage the full lifecycle of prior authorization (PA) requests in support of manufacturer-sponsored ... This is a full-time position with benefits. Please visit our Contact Us/Opportunities page on our ...

MC-Rx

Prior Authorization Coordinator

Miramar, FL · On-site

$21 - $23/hr

Manage the full lifecycle of prior authorization (PA) requests in support of manufacturer-sponsored ... This is a full-time position with benefits. Please visit our Contact Us/Opportunities page on our ...

MC-Rx

Prior Authorization Coordinator

Gainesville, GA

$21 - $23/hr

Manage the full lifecycle of prior authorization (PA) requests in support of manufacturer-sponsored ... This is a full-time position with benefits. Please visit our Contact Us/Opportunities page on our ...

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All JobsFull Time Optum Prior Authorization Jobs

Full Time Optum Prior Authorization information

What are Full Time Optum Prior Authorization jobs?

Full Time Optum Prior Authorization jobs involve reviewing and processing requests from healthcare providers to determine if certain medical procedures, medications, or services are covered under a patient’s health insurance plan. Employees in these roles work for Optum, a healthcare services company, and typically assess clinical documentation, apply medical policy guidelines, and communicate decisions to providers or members. These positions are full-time and may require collaboration with other healthcare professionals to ensure that patients receive appropriate and necessary care while managing costs.

What are some common challenges faced by Full Time Optum Prior Authorization specialists, and how can they be managed?

Full Time Optum Prior Authorization specialists often encounter challenges such as navigating complex insurance requirements, managing high call volumes, and ensuring timely approvals for patient medications or procedures. Staying organized, maintaining up-to-date knowledge of changing payer guidelines, and leveraging internal support tools can help manage these challenges. Collaboration with providers, pharmacists, and insurance representatives is key to resolving issues efficiently and providing excellent patient service.

What is the difference between Full Time Optum Prior Authorization vs Medical Claims Processor?

AspectFull Time Optum Prior AuthorizationMedical Claims Processor
CredentialsTypically requires healthcare-related certifications or experienceUsually requires medical billing or coding certifications
Work EnvironmentOffice-based, healthcare insurance settingOffice-based, insurance or healthcare organization
Employer & IndustryOptum, healthcare insurance industryHealth insurance companies, healthcare providers
Primary FocusReviewing and approving prior authorization requestsProcessing and reviewing medical claims for payment

Full Time Optum Prior Authorization specialists focus on evaluating prior authorization requests to ensure coverage approval, while Medical Claims Processors handle the processing and adjudication of medical claims. Both roles require healthcare knowledge but differ in their specific responsibilities within the insurance process.

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

To excel as a Full Time Optum Prior Authorization Specialist, you need a strong understanding of healthcare insurance processes, medical terminology, and prior authorization requirements, often supported by experience in healthcare administration. Familiarity with electronic health record (EHR) systems, claims processing software, and Optum's proprietary platforms is typically expected. Attention to detail, excellent communication, and problem-solving abilities are crucial soft skills for effectively coordinating between providers, patients, and insurance payers. These competencies ensure timely and accurate processing of authorizations, helping patients receive appropriate care while supporting organizational efficiency and regulatory compliance.
More about Full Time Optum Prior Authorization jobs
What cities are hiring for Full Time Optum Prior Authorization jobs? Cities with the most Full Time Optum Prior Authorization job openings:
What are the most commonly searched types of Optum Prior Authorization jobs? The most popular types of Optum Prior Authorization jobs are:
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What job categories do people searching Full Time Optum Prior Authorization jobs look for? The top searched job categories for Full Time Optum Prior Authorization jobs are:
Full Time Optum Prior Authorization jobs near you
Infographic showing various Full Time Optum Prior Authorization job openings in the United States as of June 2026, with employment types broken down into 50% Part Time, and 50% Nights. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.
Prior Authorization Specialist

Prior Authorization Specialist

Insight Global Healthcare

Middletown, NJ • On-site

$22 - $25/hr

Full-time

Medical, Dental, Retirement, PTO

Posted 4 days ago

Job description

Insight Global's client is seeking a detail-oriented Prior Authorization Specialist to support a growing plastic and reconstructive surgery practice in Red Bank, NJ. This role is heavily focused on true prior authorization work, including initiating authorizations, tracking pending cases, following up with payers, supporting denial workflows, and ensuring documentation is complete and accurate for downstream billing and collections teams.
This person will support assigned physicians, manage authorization timelines tied to patient procedures, and work closely with surgical coordinators, providers, insurance carriers, and internal teams to help ensure services are approved prior to being performed. The ideal candidate is organized, proactive, timeline-driven, and comfortable working in a fast-paced healthcare environment where follow-through and attention to detail are critical.
Day-to-Day Responsibilities
-Initiate, track, and follow up on prior authorizations for scheduled procedures and medical services.
-Manage authorization work for assigned physicians, typically supporting approximately four doctors and initiating an average of three new authorizations per day, with the remainder of the workload focused on follow-ups, pending cases, audits, and documentation updates.
-Use insurance payer portals such as Availity and Navinet to verify benefits, submit authorization requests, check status updates, and document payer responses.
-Review patient insurance coverage and ensure all supporting documentation, medical records, and required forms are complete prior to submission.
-Follow up on pending authorizations based on urgency and procedure timing, with consistent updates to spreadsheets, notes, and internal tracking tools.
-Communicate authorization status, payer requirements, denials, trends, and urgent issues to surgical coordinators, physicians, and internal staff.
-Support denial workflows by notifying surgical coordinators, helping coordinate peer-to-peer reviews, tracking determinations, and assisting with appeal submissions when needed.
-Maintain clear, accurate, standardized documentation of all payer communications, provider interactions, follow-ups, and case updates.
-Prioritize cases based on patient procedure dates and urgency, including last-minute pending cases that may require strong ownership and follow-through.
-Maintain HIPAA compliance and protect patient and company confidentiality at all times.
Compensation:
$22 to $25 per hour.
Benefits:
-Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance
-401k and Profit sharing
-Paid Time Off
-Contribution to Health Benefits
-Company Discounts on Products & Services

Company Description

WellMed is a physician-led medical group + clinic network under Optum focused on caring for Medicare patients (mostly seniors). Run primary care clinics to operate outpatient primary care clinics across markets like Florida to provide primary care visits, preventative care ,chronic disease management, etc.