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Remote Optum Prior Authorization Jobs (NOW HIRING)

CareMed Specialty Pharmacy

$23 - $25/hr

Pharmacy Prior Authorization Specialist - CareMed Specialty Pharmacy Buffalo, NY | Full-Time | ... Remote work possible after initial on-site training. Company Benefits * Medical; Dental; Vision ...

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 ... Remote About DxTx Pain & Spine At DxTx Pain & Spine, we're redefining how pain and spine practices ...

G-TECH Services

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Prior Authorization Specialist (REMOTE)

Detroit, MI · Remote

$39K - $43K/yr

MUST HAVE PRIOR AUTHORIZATION EXPERIENCE AND AN ACTIVE CPHT. IF YOU FEEL YOU ARE QUALIFIED, ADD ... The expectation is they would be work fully remote, but we would offer the option to work on site ...

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Remote Optum Prior Authorization information

What is the difference between Remote Optum Prior Authorization vs Remote Optum Claims Reviewer?

AspectRemote Optum Prior AuthorizationRemote Optum Claims Reviewer
CredentialsTypically requires healthcare-related certifications, such as RN, LPN, or medical coding credentialsOften requires similar healthcare certifications, with focus on claims processing
Work EnvironmentRemote, healthcare insurance setting, interacting with providers and patientsRemote, insurance claims processing environment, reviewing submitted claims
Employer & Industry UsageCommonly employed by health insurance companies like Optum, focusing on authorization processesEmployed by insurance companies, focusing on claims review and reimbursement

Remote Optum Prior Authorization specialists focus on obtaining approvals for healthcare services, while Remote Optum Claims Reviewers evaluate submitted claims for accuracy and reimbursement. Both roles require healthcare knowledge and certifications, but differ in their primary functions within the insurance process.

What is a Remote Optum Prior Authorization job?

A Remote Optum Prior Authorization job involves reviewing and processing requests from healthcare providers to determine whether certain medical procedures, medications, or services will be covered under a patient's insurance plan. Employees in this role work from home and use clinical guidelines to assess the necessity and appropriateness of requested treatments. They collaborate with providers, patients, and insurance teams to ensure timely authorization decisions. This position typically requires strong communication skills, attention to detail, and familiarity with healthcare regulations and insurance policies.

What are the key skills and qualifications needed to thrive as a Remote Optum Prior Authorization Specialist, and why are they important?

To thrive as a Remote Optum Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and prior authorization protocols, typically supported by a healthcare-related degree or relevant experience. Familiarity with electronic health record (EHR) systems, insurance verification tools, and prior authorization software is essential. Excellent attention to detail, organizational skills, and effective communication are vital soft skills for efficiently managing high volumes of authorization requests and collaborating with providers. These skills ensure accurate, timely approvals and help optimize patient care while reducing administrative delays.

How does a Remote Optum Prior Authorization specialist typically interact with healthcare providers and insurance teams?

As a Remote Optum Prior Authorization specialist, you will regularly communicate with healthcare providers, pharmacies, and insurance representatives to obtain and verify necessary information for authorizing medical procedures or medications. Most interactions occur via phone, secure messaging, or electronic health record systems, requiring clear communication and attention to detail. Collaboration is essential, as you'll often need to clarify clinical documentation with providers and ensure compliance with insurance guidelines. This role is well-suited for those who are organized, proactive, and comfortable working independently within a supportive virtual team environment.
More about Remote Optum Prior Authorization jobs
What cities are hiring for Remote Optum Prior Authorization jobs? Cities with the most Remote 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 Remote Optum Prior Authorization jobs? States with the most job openings for Remote Optum Prior Authorization jobs include:
What job categories do people searching Remote Optum Prior Authorization jobs look for? The top searched job categories for Remote Optum Prior Authorization jobs are:
Remote Optum Prior Authorization jobs near you
Infographic showing various Remote Optum Prior Authorization job openings in the United States as of June 2026, with employment types broken down into 97% Full Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.
Prior Authorization Specialist / Remote

Prior Authorization Specialist / Remote

BrightSpring Health Services

Englewood, CO • Remote

$22 - $26/hr

Full-time

Posted 25 days ago

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BrightSpring Health Services rating

4.8

Company rating: 4.8 out of 10

Based on 62 frontline employees who took The Breakroom Quiz

216th of 232 rated social care providers

Job description

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.

Shift: Monday-Friday 9:00am-5:30pm


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

What BrightSpring Health Services employees say

Pay

Benefits

Hours and flexibility

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