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Full Time Optum Prior Authorization Jobs (NOW HIRING)

OU Health

Prior Authorization Specialist II

Central Park, WA · Remote

$19.25 - $25.50/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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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:
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 June 2026, with employment types broken down into 1% As Needed, and 99% Full Time. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.
Senior Prior Authorization Specialist

Senior Prior Authorization Specialist

CareMed Specialty Pharmacy

Houston, TX • On-site, Remote

$23 - $25/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 2 days ago

Job description

Senior Pharmacy Prior Authorization Specialist – CareMed Specialty Pharmacy
Houston, TX | Full-Time | Starting at $25.00/hr and up
Sign-On Bonus: $5,000 for employees starting before July 31, 2026.
CareMed Specialty Pharmacy is seeking a Senior Pharmacy Prior Authorization Specialist to join our dedicated team in Louisville, KY. 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 Senior Pharmacy Prior Authorization Specialist will work closely with the Prior Authorization Manager and supervisor to ensure completion of challenging cases and escalations in their designated vertical. They will initiate prior authorizations, complete prior authorization forms via webtools such as CoverMyMeds or insurance specific forms including clinical information from clinical notes provided by prescribers, adjudicate test or live claims to review
rejections, and follow up on PA requests with insurance companies, while taking prescriber preferences into account.
Senior Prior Authorization Specialists may also assist with training employees, and other duties as assigned.
How You’ll Do This
  • Works and resolve difficult or escalated cases to assist in processing prescription orders
  • Participates in the orientation and training of prior authorization specialists within workflow vertical.
  • Escalates workflow/process improvement ideas to leadership
  • Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.
  • Runs test claims or live claims to check for payable claims or for valid insurance rejections on medications that require prior authorizations and initiate Prior Authorization requests, using appropriate insurance forms, portals or CoverMyMeds. Reviews accuracy and completeness of information and ensure supporting clinical documentation is included if required.
  • Contacts insurance companies and providers to follow up on prior authorization requests, including
    determining if any additional information is needed, or whether the claim is in review, approved, or denied.
  • Document all prior authorization information in patient profile.
  • Facilitates process for requesting and follow up of prior authorizations with prescribers through preferred contact methods noted in prescriber/patient profiles.
  • Provides guidance to providers and patients in connection with documentation required for payer coverage, support with appeals for denied claims, and follow up with payer to determine outcome.
    Senior Prior Authorization Specialist
  • Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conducts 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.
What You Bring
Required:
  • High School Diploma or GED. Previous Experience in Experience in Pharmacy and Prior Authorizations
  • 2+ years pharmacy or prior authorization experience
  • Registration with Board of Pharmacy (as required by state law)
  • Prior authorization process, CoverMyMeds experience, knowledge/understanding of pharmacy
    insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim
    rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related
    knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic
    names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
Preferred:
  • Associates or Bachelor’s Degree
  • Certified Pharmacy Technician (PTCB), Advanced Certified Pharmacy Technician
  • 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.
Company Values: Teamwork, Respect, Integrity, Passion

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