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Remote Optum Prior Authorization Jobs in California

LIBERTY DENTAL

$150K - $165K/yr

In this fully remote position, you'll use your clinical judgment to review claims and prior authorizations, helping ensure members receive the right care at the right time. Your work directly ...

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Remote Optum Prior Authorization information

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.

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 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.

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 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 1% As Needed, 78% Full Time, 18% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

UM Coordinator (SNF / Post-Acute Authorizations) California Residents

A-Line Staffing Solutions

Alameda, CA • Remote

Full-time

Posted 4 days ago

Job description

It's a strong base, but for Haley you'll usually get better applicant flow and better self-filtering if we make it tighter, more keyword-dense, and more "this is exactly SNF transitions/authorizations" (while still clean and skimmable). Below is a better Haley-optimized version (still within your rules, 300–400 words, no company name, no temp language). Long Term Care Coordinator (SNF / Discharge Planning) – Remote (California) Location: Remote (California residents only) Schedule: Monday–Friday, 8:00 AM–5:00 PM (Pacific Time) Pay: Not provided Summary Hiring a Long Term Care Coordinator with hands-on SNF (Skilled Nursing Facility) coordination experience in a managed care setting.

This Long Term Care Coordinator supports post-acute transitions and authorization workflows for Medi-Cal/Medicare members, with a heavy focus on hospital-to-SNF placement, continued stay tracking, bed holds/LOA, discharge planning support, and documentation. If you've worked directly with SNF admissions teams and hospital discharge planners and you understand UM/authorization processes, this is a high-match role.

Responsibilities

Coordinate SNF admissions, continued stay reviews, and transitions of care (hospital → SNF, SNF → home, LTACH/IRF as applicable) Process, track, and follow up on SNF/LTC authorizations and related supportive services (DME, home health, therapies, transportation) Partner with SNF staff, hospital discharge planners, providers, and members/families to remove barriers and ensure timely placement/discharge Review clinical documentation to support level of care and medical necessity requirements Maintain accurate case notes and status updates in UM/case management systems; meet productivity and turnaround-time expectations Monitor pending items, request missing records, and escalate delays or high-risk cases appropriately Support compliance with managed care policies, procedures, and regulatory documentation standards (HIPAA) Qualifications Recent experience coordinating with Skilled Nursing Facilities (SNF) on admissions, transitions, and discharge planning workflows Experience in managed care operations: UM/UR support, prior authorization, referrals, and documentation-driven processing Working knowledge of Medi-Cal and Medicare member populations and provider network workflows Strong organizational skills with high-volume follow-up, documentation accuracy, and time-sensitive processing Clear, professional communication with providers, facilities, and members; HIPAA/privacy compliant Preferred: experience with InterQual or MCG (Milliman) and post-acute authorization platforms Preferred: experience with bed holds / leave of absence (LOA) and post-acute benefit coordination

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About A-Line Staffing Solutions

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A-Line Staffing Solutions is an established full-service recruiting and staffing provider that operates in the industry of human resources and recruitment. Based in Utica, Michigan, A-Line Staffing Solutions has been committed to its mission of providing innovative and effective workforce solutions since its foundation. The company specializes in providing high-quality staffing solutions for a range of disciplines, including Information Technology, Professional, Administrative, Healthcare, and more. A-Line prides itself on its ability to offer comprehensive and tailored staffing solutions in line with the varying needs of different businesses, which has played a crucial role in the company's growth and success.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Utica, MI, US

Year founded

2004

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