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Full Time Optum Prior Authorization Jobs (NOW HIRING)

OU Medical Center

Prior Authorization Specialist II

$18.50 - $24.50/hr

Prior Authorization Specialist II Department: Pre-visit Services New to OU Health? Ask your ... Candidates must reside and work full-time in OK before their first day of employment. SHIFT: M-F ...

OU Health

Prior Authorization Specialist II

$18.50 - $24.50/hr

Prior Authorization Specialist II Department: Pre-visit Services New to OU Health? Ask your ... Candidates must reside and work full-time in OK before their first day of employment. SHIFT: M-F ...

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Full Time Optum Prior Authorization information

What is a full time Optum prior authorization specialist?

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 skills and qualifications are needed to thrive as a full time Optum prior authorization specialist?

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.

What are 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.

More about Full Time Optum Prior Authorization jobs

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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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Full Time Optum Prior Authorization jobs near you
Infographic showing various Full Time Optum Prior Authorization job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 77% Full Time, 19% Part Time, 1% Temporary, and 2% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

Prior Authorization Specialist / Remote

Englewood, CO • Remote

Amerita
Pharmaceutical and Medicine Manufacturing • 501 - 1,000 employees
Learn more about Ameritaexternal

$21 - $26/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 15 days ago

Job description

Our Company

Amerita

Overview

This role will be responsible for activities relating to the proper initiation, clinical review, submission, and follow up of prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process.

Schedule:Monday - Friday 9:30am - 6:30pm CST

We Offer:

Competitive Pay 

Health, Dental, Vision & Life Insurance

Company-Paid Short & Long-Term Disability Flexible Schedules & Paid Time Off Tuition Reimbursement  Employee Discount Program & DailyPay 401k

Pet Insurance

Responsibilities
  • Initiate, process, and oversee the clinical review of prior authorization requests for medication and supply, ensuring compliance with payer requirements and clinical guidelines.
  • Collaborate with healthcare providers, insurance companies, and patients to gather necessary clinical information and documentation to support prior authorization submissions.
  • Submit prior authorization requests accurately and in a timely manner, utilizing electronic submission platforms and following established protocols.
  • Knowledgeable to perform all PA functions.
Qualifications
  • High School Diploma or GED or licensed/registered pharmacy technician or previous experience in Pharmacy
  • 1+ years pharmacy experience
  • Pharmacy or healthcare-related knowledge
  • Knowledge of pharmacy terminology including sig codes, and Roman numbers, brand/generic names of medication
  • Basic math and analytical skills
  • Intermediate typing/keyboard skills
About our Line of BusinessAmerita, an affiliate of BrightSpring Health Services, is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness, and entrepreneurial spirit of a local provider. For more information, please visit www.ameritaiv.com. Follow us on Facebook, LinkedIn, and X.  Additional Job Information

Percentage of Travel:  0-25%

Salary RangeUSD $21.00 - $26.00 / HourEmployment Type: FULL_TIME

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