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Full Time Optum Prior Authorization Jobs (NOW HIRING)

CareMed Specialty Pharmacy

$23 - $25/hr

This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training. Company Benefits * Medical; Dental; Vision * 401k with a match * Paid Time ...

PainPoint

Prior Authorization Coordinator

Atlanta, GA · On-site +1

$19 - $21/hr

Prior Authorization Coordinator Full-Time | $19-21/hour | Monday-Friday | 8:00 AM-4:30 PM CST Location: Remote About DxTx Pain & Spine At DxTx Pain & Spine, we're redefining how pain and spine ...

MC-Rx

Prior Authorization Coordinator

Gainesville, GA · 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 · 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 ...

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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:
What states have the most Full Time Optum Prior Authorization jobs? States with the most job openings for Full Time Optum Prior Authorization jobs include:
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 July 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Prior Authorization Specialist

CareMed Specialty Pharmacy

Waltham, MA • On-site, Remote

$23 - $28/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted yesterday

Job description

Pharmacy Prior Authorization Specialist – CareMed Specialty Pharmacy
Waltham, MA | Full-Time | Starting at $23.00/hr and up
Sign-On Bonus: $5,000 for employees starting before August 31, 2026!
Join a mission-driven team making a difference in the lives of cancer and rare disease patients.
CareMed Specialty Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our dedicated team in Waltham, MA. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.
Company Benefits
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Quarterly Incentive Bonus
  • Paid Volunteer Day
  • Referral Incentive Program
  • Company Paid Life Insurance; and Short/Long-Term Disability
Why Join Us?
  • A career with purpose: Help patients access life-saving medications.
  • Supportive culture: We value teamwork, respect, integrity, and passion.
  • Growth opportunities: We invest in your professional and personal development.
What You’ll Do
The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
How You’ll Do This
  • Manage prior authorization requests and appeals with insurance carriers.
  • Collaborate with physicians, pharmacists, and other departments.
  • Ensure HIPAA compliance while handling sensitive patient information.
  • Maintain accurate documentation of authorization details.
  • Proactively monitor and renew expiring authorizations.
What You Bring
Required:
  • High School Diploma or GED
  • 1+ years of pharmacy or prior authorization experience
  • Registration with Board of Pharmacy (as required by state law)
  • Strong communication, organizational, and customer service skills
  • Self-motivated, organized, detail-oriented, and adaptable to changing priorities
  • Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds
Preferred:
  • Associate degree or Certified Pharmacy Technician (PTCB)
  • 3+ years of experience in pharmacy or prior authorizations
  • Specialty pharmacy experience
Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.

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