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Prior Authorization Jobs in California (NOW HIRING)

Akido

Clinical Review Nurse - Prior Authorization

Chino, CA · On-site

$62K - $93K/yr

The Clinical Review Nurse - Prior Authorization & Case Management is responsible for reviewing and processing prior authorization requests to ensure medical necessity, appropriate level of care, and ...

Akido

Clinical Review Nurse - Prior Authorization

Chino, CA · On-site

$62K - $93K/yr

The Clinical Review Nurse - Prior Authorization & Case Management is responsible for reviewing and processing prior authorization requests to ensure medical necessity, appropriate level of care, and ...

Akido

Clinical Review Nurse - Prior Authorization

Chino, CA · On-site

$62K - $93K/yr

The Clinical Review Nurse - Prior Authorization & Case Management is responsible for reviewing and processing prior authorization requests to ensure medical necessity, appropriate level of care, and ...

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Showing results 21-40

All JobsPrior Authorization JobsPrior Authorization Jobs in California

Prior Authorization information

See California salary details

$13

$20

$31

How much do prior authorization jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for prior authorization in California is $20.62, according to ZipRecruiter salary data. Most workers in this role earn between $17.07 and $22.79 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a prior authorization specialist, and why are they important?

To thrive as a Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and healthcare regulations, typically supported by a high school diploma or associate degree in a healthcare-related field. Familiarity with electronic medical records (EMR) systems, insurance portals, and authorization management software is essential. Attention to detail, effective communication, and problem-solving abilities help you navigate complex cases and collaborate with providers and payers. These skills ensure accurate and timely processing of authorizations, minimizing delays in patient care and reducing administrative errors.

What are some common challenges faced by prior authorization specialists, and how can applicants prepare for them?

Prior Authorization specialists often encounter challenges such as navigating complex insurance policies, managing high volumes of requests, and communicating effectively with both healthcare providers and insurance representatives. To prepare for these challenges, applicants should develop strong organizational skills, attention to detail, and a good understanding of medical terminology and insurance guidelines. Familiarity with electronic health records (EHR) systems and the ability to multitask in a fast-paced environment are also valuable assets in this role.

What is the difference between Prior Authorization vs Medical Billing Specialist?

AspectPrior AuthorizationMedical Billing Specialist
CredentialsTypically requires knowledge of insurance policies, healthcare regulations, and sometimes certifications like NCQA or AHIPRequires knowledge of coding, billing procedures, and often certifications like CPC or CCS
Work EnvironmentHealthcare provider offices, insurance companies, or hospitalsMedical offices, billing companies, or healthcare facilities
Employer & Industry UsageUsed by healthcare providers and insurers to approve treatments or proceduresUsed by healthcare providers and billing companies to process claims and payments

While both roles are essential in healthcare administration, Prior Authorization focuses on obtaining approval for treatments, whereas Medical Billing Specialists handle the financial aspects of claims processing. Understanding their differences helps clarify their distinct responsibilities within the healthcare system.

How do I become a prior authorization specialist?

To become a prior authorization specialist, you typically need a high school diploma or equivalent and gain experience in healthcare or insurance billing. Relevant skills include knowledge of medical terminology, insurance policies, and proficiency with electronic health record (EHR) systems; certifications such as Certified Medical Administrative Assistant (CMAA) can also enhance job prospects.

What is a prior authorization job?

A prior authorization job involves reviewing and processing requests from healthcare providers to approve specific medical treatments, medications, or procedures before they are administered. The role requires knowledge of insurance policies, medical terminology, and attention to detail, often utilizing electronic health record systems. It is essential for ensuring that treatments meet insurance criteria and are covered under the patient's plan.

What are the career paths in prior authorization?

Careers in prior authorization typically include roles such as prior authorization specialists, medical reviewers, and healthcare administrators. Advancement can lead to supervisory or managerial positions, and professionals often develop skills in healthcare regulations, insurance policies, and medical coding. Certifications in medical billing and coding can enhance career growth in this field.

What is prior authorization?

Prior authorization is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication. Before the provider delivers the service, they must receive approval from the insurer. This process helps control costs and ensures that the service or medication is medically necessary. It often involves submitting documentation and waiting for a decision, which can sometimes delay patient care. Patients and providers should check with insurance companies to understand which services require prior authorization.
More about Prior Authorization jobs

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

The most popular types of Prior Authorization jobs in California are:

What are popular job titles related to Prior Authorization jobs in California?

For Prior Authorization jobs in California, the most frequently searched job titles are:

What job categories do people searching Prior Authorization jobs in California look for?

The top searched job categories for Prior Authorization jobs in California are:

What cities in California are hiring for Prior Authorization jobs?

Cities in California with the most Prior Authorization job openings:

Prior Authorization jobs near you
Infographic showing various Prior Authorization job openings in California as of August 2026, with employment types broken down into 89% Full Time, and 11% Part Time. Highlights an 100% In-person job distribution, with an average salary of $42,890 per year, or $20.6 per hour.

Prior Authorization Pharmacy Technician

Healthcare Support Staffing

Glen Ellen, CA

$19.75 - $24/hr

Full-time

Medical, Dental, Vision

Re-posted 15 days ago

Job description

Company Description

Anthem, Inc. is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With more than 73 million people served by its affiliated companies including nearly 40 million enrolled in its family of health plans, Anthem is one of the nation's leading health benefits companies.

One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.
We offer a broad range of medical and specialty products.

Job Description

Candidate will be working in the MagellanRX call center and will be responsible for answering around 30-50 calls per day (majority being inbound). Calls may be from enrollees, doctor offices or pharmacies and topics can include Prescription Approvals, Intiail/Prior Authorization, Claims, ID Cards, DUR (Drug Utilization Review) rejection, etc.

 Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers.

 Essential Functions:

  • Determines appropriateness for medications.
  • Communicates decision to physicians, physician's office staff, medical management staff and/or pharmacists.
  • Researches, resolves and documents prior authorization outcomes in pharmacy system.
  • Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician's office staff, medical management staff and/or pharmacists.
  • Escalates requests to Pharmacist when request requires extensive clinical review or denial.
  • Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management
  • Performs other duties as required
Qualifications
  • Must have either a Pharm Tech Certification(CPT) in the state of VA or have the PTCB (national certification)
  • At least 6 months of dispensing or retail experience (equivalent internal training will be substituted)
  • Previous reimbursement experience and/or working in a health plan/healthcare setting
  • In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary (preferred drug list) management techniques (ability to objectively discriminate between superior and marginal medications), medical terminology and/or current diagnostic/reimbursement clinical criteria
  • Knowledge of prior auth
  • Ability to identify and trouble-shoot problematic issues
  • Proficiency in Pharmacy computerized systems and software applications and MS Office Product Suite
Additional Information

Advantages of this Opportunity:

Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
Monday through Friday 8am-5pm


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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