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Remote Optum Prior Authorization Jobs in Colorado

Valeris

Remote Field Reimbursement Manager

Denver, CO · Remote

As a Remote Field Reimbursement Manager you will help support patient access to critical therapies ... prior authorizations, appeals processes, and patient support financial assistance offerings. This ...

Stryker

$35/hr

Must be legally authorized to work in the U.S. and not require employment-based sponsorship now or ... Prior exposure to claims databases (Medicare, MarketScan, Premier PINC AI, Optum) or EHR data ...

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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 popular job titles related to Remote Optum Prior Authorization jobs in Colorado?

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

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

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

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

Cities in Colorado 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 Colorado as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 21% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Prior Authorization Specialist / Remote

BrightSpring

Englewood, CO • Remote

$26/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

BrightSpring Health Services rating

4.9

Company rating: 4.9 out of 10

Based on 65 frontline employees who took The Breakroom Quiz

224th of 247 rated social care providers

Job description

Our Company
Amerita
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.
Schedule:
Monday - Friday
9:30am - 6:30pm CST
We Offer:
• Competitive Pay
• Health, Dental, Vision & Life Insurance
• Company-Paid Short & Long-Term Disability
• Flexible Schedules & Paid Time Off
• Tuition Reimbursement
• Employee Discount Program & DailyPay
• 401k
• Pet Insurance
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

About our Line of Business
Amerita, an affiliate of BrightSpring Health Services, is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness, and entrepreneurial spirit of a local provider. For more information, please visit www.ameritaiv.com. Follow us on Facebook, LinkedIn, and X.
Additional Job Information
Percentage of Travel: 0-25%
Salary Range
USD $21.00 - $26.00 / Hour

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