ZipRecruiter

Log In

1

Manager Cvs Prior Authorization Jobs in Oregon (NOW HIRING)

Moda Health

Govt Prior Auth Coord I

Portland, OR · On-site +1

$21.30 - $23.96/hr

Position Summary This position will provide support to the Medical Management team by assisting in the investigation and research of prior authorization requests. Completes reviews or support the ...

AgeRight

Eligibility & Authorization Coordinator

Milwaukie, OR · On-site

$19.75 - $24.50/hr

Obtain and track prior authorizations and recertifications. Review referrals for payer requirements ... Knowledge and Skills Knowledge of Medicare, Medicaid, managed care, EMR systems, payer regulations ...

Aviary

Senior PCP Referral Expert

OR · On-site +1

$30/hr

Senior Enrollment Operations Manager Location: United States Compensation: $30 per hour (no ... Insurance Benefits & Prior Authorization Support As business needs arise, this role may also ...

McKesson

Field Reimbursement Manager

OR · On-site +1

Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare ... Resumes or CVs submitted to this email box will not be accepted. Join us at McKesson!

McKesson

Field Reimbursement Manager

OR · On-site +1

Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare ... Resumes or CVs submitted to this email box will not be accepted. Join us at McKesson!

Healthcare Support Staffing

Pharmacist

Portland, OR · On-site

$61.75 - $74.25/hr

... management, DUR programs, medication prior authorization, and others. Assess, review and respond to federal and state regulatory requirements/audits of the pharmacy benefit Consult with clinicians ...

next page

Showing results 1-20

All JobsCvs Prior Authorization JobsManager Cvs Prior Authorization JobsManager Cvs Prior Authorization Jobs in Oregon

Manager Cvs Prior Authorization information

What is a manager CVS prior authorization?

A Manager CVS Prior Authorization oversees teams responsible for processing and managing prior authorization requests for prescription medications at CVS Health. This role involves ensuring that insurance requirements are met before medications are dispensed, improving workflow efficiency, and maintaining compliance with regulations. Managers also train and supervise staff, monitor performance, and collaborate with other departments to resolve complex authorization cases. The position requires strong leadership, attention to detail, and knowledge of healthcare and pharmacy benefit management.

What are the key skills and qualifications needed to thrive as a manager CVS prior authorization?

To thrive as a Manager of CVS Prior Authorization, you need a strong background in pharmacy or healthcare administration, expertise in insurance processes, and often a relevant degree such as a PharmD, RN, or healthcare management certification. Familiarity with pharmacy benefit management (PBM) software, prior authorization systems, and electronic health records (EHRs) is typically required. Exceptional leadership, problem-solving, and communication skills are crucial for managing teams and interacting with healthcare providers and payers. These skills ensure efficient operations, compliance with regulations, and improved patient access to necessary medications.

How does a manager CVS prior authorization collaborate with pharmacists and healthcare providers to streamline the approval process?

As a Manager of CVS Prior Authorization, you will regularly coordinate with pharmacists, healthcare providers, and insurance representatives to ensure timely approvals for prescribed medications. Effective communication and problem-solving skills are essential, as you'll often need to clarify clinical information, resolve escalated cases, and develop process improvements. This collaboration not only helps reduce delays for patients but also enhances operational efficiency within your team. Expect to lead cross-functional meetings and implement training to keep everyone aligned with regulatory and policy changes.

What is the difference between Manager Cvs Prior Authorization vs Pharmacist?

AspectManager Cvs Prior AuthorizationPharmacist
CredentialsTypically requires managerial experience, healthcare administration knowledge, and sometimes a certification in healthcare managementRequires a pharmacy degree (Doctor of Pharmacy) and licensure
Work EnvironmentOffice setting, healthcare administration, insurance companies, or pharmacy benefit managementRetail or hospital pharmacy, clinical settings
Employer & IndustryHealth insurance companies, pharmacy benefit managers, healthcare organizationsCommunity pharmacies, hospitals, clinics
Primary ResponsibilitiesOverseeing prior authorization processes, managing staff, ensuring complianceDispensing medications, patient counseling, verifying prescriptions

The main difference between a Manager Cvs Prior Authorization and a Pharmacist lies in their roles and credentials. Managers focus on overseeing authorization processes and administrative tasks within healthcare organizations, while pharmacists are licensed professionals responsible for dispensing medications and patient care. Both roles are essential in the healthcare and pharmacy industry but serve distinct functions.

What are the most commonly searched types of Cvs Prior Authorization jobs in Oregon?

The most popular types of Cvs Prior Authorization jobs in Oregon are:

What are popular job titles related to Manager Cvs Prior Authorization jobs in Oregon?

For Manager Cvs Prior Authorization jobs in Oregon, the most frequently searched job titles are:

What job categories do people searching Manager Cvs Prior Authorization jobs in Oregon look for?

The top searched job categories for Manager Cvs Prior Authorization jobs in Oregon are:

What cities in Oregon are hiring for Manager Cvs Prior Authorization jobs?

Cities in Oregon with the most Manager Cvs Prior Authorization job openings:

Manager Cvs Prior Authorization jobs near you
Infographic showing various Manager Cvs Prior Authorization job openings in Oregon as of August 2026, with employment types broken down into 83% Full Time, 15% Part Time, 1% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution.

RCM Prior Authorization Specialist - Remote

Slocumcenter

Eugene, OR • On-site

$50 - $70/hr

Other

Posted 3 days ago

New

Job description

  • Submits, tracks, and manages prior authorization requests for medical and ancillary procedures, within strict timeframes.
  • Researches and resolves authorization and referral claim denials, while coordinating with physicians, providers, and insurance payers to file appeals or facilitate a P2P.
  • Reviews patient medical records and clinical documentation to ensure they meet payer coverage criteria.
  • Collaborate with the RCM Prior Authorization Supervisor and Team Lead to develop and update authorization policies and procedures.
  • Maintain knowledge of payer guidelines (Medicare, Medicaid, Commercial, etc.) and ensuring regulatory compliance.
  • Partner with the RCM Prior Authorization Supervisor and Team Lead to analyze denied claims resulting from prior authorization and referral errors by identifying the root cause and provide the corrected data to the billing team for the purpose of appealing or resubmitting a corrected claim.
  • Interacts with insurance payers, physicians, providers, and Slocum departments to clarify coverage requirements to expedite approvals.
  • Work in collaboration with the RCM Prior Authorization Supervisor and Team Lead to monitor prior authorization related utilization trends, claim denials, denial rates, and provide performance improvement suggestions to senior leadership.
  • Communicate cross-functionally with providers and other Slocum departments regarding patient questions or referral and authorization concerns.
  • Perform other duties as assigned
  • 2 – 5 years of previous experience as a Prior Authorization Specialist, with expertise in medical billing, healthcare, and the insurance referral process.
  • Strong understanding of medical terminology, ICD-10, CPT, and HCPC coding, and insurance payer policies.
  • Ability to train staff, manage high-volume workflows, and mentor team members.
  • Proficiency in medical billing software / Electronic Health Records (NextGen preferred).
  • Be able to read and understand digital and paper insurance Explanation of Benefits.
  • Strong attention to detail (Accuracy in code selection is critical for compliance and reimbursement.
  • Familiarity with CMS and insurance payer guidelines and requirements.
  • Proficient with Microsoft Office Suites (Outlook, Word, and Excel).
  • Possess the ability to prioritize workload daily, weekly and monthly.
  • Strong communication, attention to detail, and problem-solving skills
Summary
  • The RCM Prior Authorization Specialist manages insurance approvals for medical and ancillary services. Monitor the accuracy of prior authorization activity and payer requirements. Act as a liaison between providers, patients, payers. Ability to learn and retain new workflows and changes in insurance payer requirements. Ensure a high level of accuracy in clinical documentation submissions. Handle denials and appeals.
#J-18808-Ljbffr

Apply