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Remote Optum Prior Authorization Jobs in California

talentpluto

Account Executive

San Francisco, CA · On-site +1

$220K - $300K/yr

Remote Industry: Health tech / AI Compensation: $110K-$150K base, $220K-$300K OTE About the Company Our partner is a seed-stage health-tech company using agentic AI to solve prior authorization for ...

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All JobsOptum Prior Authorization JobsRemote Optum Prior Authorization JobsRemote Optum Prior Authorization Jobs in California

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?

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.

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

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

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

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

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

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

What cities in California are hiring for Remote Optum Prior Authorization jobs?

Cities in California with the most Remote Optum Prior Authorization job openings:

Remote Optum Prior Authorization jobs near you
Infographic showing various Remote Optum Prior Authorization job openings in California as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 100% Remote job distribution.

Medical Director - Prior Authorization - CA licensure required - Remote

UnitedHealth Group

Torrance, CA • On-site, Remote

$248K - $373K/yr

Full-time

Retirement

Posted 19 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

188th of 887 rated healthcare providers

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 4 industry leader.
This position will support the growing Prior Auth program which covers the California Market. The scope of this role will include Prior Authorization for Medicare Advantage members focusing on high value procedures such as Myocardial SPECT, PET scans, DME/Home Ventilator, Genetic Testing, and many more. Additionally, the team handles UM functions for the California Market.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Work to improve quality and promote evidence-based medicine
  • Prior authorization, utilization management and claims review cases for patients
  • Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement
  • Support initiatives that enhance quality throughout our national network
  • Ensure the right service is provided at the right time for each member
  • Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review
  • Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • MD or DO degree
  • Active, unrestricted physician state license in CA
  • Current board certification through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
  • 5+ years of clinical practice experience post residency
  • Proven solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles

Preferred Qualifications:
  • Hands-on utilization and/or quality management experience
  • Prior Authorization experience
  • Project management or active project participation experience
  • Substantial experience in using electronic clinical systems
  • Licensure in New Mexico, Utah, Nevada, or Arizona (or willing and able to obtain)

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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