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Remote Optum Prior Authorization Jobs in Florida

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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?

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 Florida? The most popular types of Optum Prior Authorization jobs in Florida are:
What are popular job titles related to Remote Optum Prior Authorization jobs in Florida? For Remote Optum Prior Authorization jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Remote Optum Prior Authorization jobs in Florida look for? The top searched job categories for Remote Optum Prior Authorization jobs in Florida are:
What cities in Florida are hiring for Remote Optum Prior Authorization jobs? Cities in Florida 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 Florida as of August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 100% Remote job distribution.

Oncology Prior Authorization Case Manager, Non-RN - Remote

University of Miami

Miami, FL • On-site, Remote

Full-time

Medical, Dental

Re-posted 23 days ago

University Of Miami rating

7.7

Company rating: 7.7 out of 10

Based on 52 frontline employees who took The Breakroom Quiz

258th of 617 rated colleges and universities

Job description

Current Employees:

If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet.

The University of Miami Health System Department of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent conducts initial, concurrent and retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team for optimal and efficient patient outcomes, while avoiding treatment delays and authorization denials. They are accountable for a designated patient caseload and provide intervention and coordination to decrease avoidable delays, at all times they provide communication of progress and or determination to the clinical team and or the patient. He/she monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers. Evaluates the needs of the patient, the resources available, and recommends and facilitates for the best outcome to meet ongoing patient needs that encourages compliance with medical advice.

CORE FUNCTIONS:

  • Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of care services

  • Follows the authorization process using established criteria as set forth by the payer or clinical guidelines

  • Accurate review of coverage benefits and payer policy limitations to determine appropriateness of requested services

  • Refers to the treatment plan for clinical reviews in accordance with established criteria and guidelines

  • Facilitates communication of denials and or Peer to Peer requests between payers and the healthcare team

  • Identifies potential delays in treatment or inappropriate utilization by reviewing the treatment plan, serves as a resource to provide education regarding payer policies and assists with coordination of alternative treatment options

  • Ensures and Maintains effective communication regarding authorization status and determination to the clinical team and on occasion the patient.

  • Proactive communication with leadership regarding barriers and or potential delays in care Identifies opportunities for expedited requests and prioritizes caseload accordingly

  • Maintains knowledge regarding payer reimbursement policies and clinical guidelines.

  • This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS:

Education:

Bachelor's degree in relevant field; or equivalent

Experience:

Minimum of 2 years of relevant experience

Oncology - Preferred

Any relevant education, certifications and/or work experience may be considered

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

Job Status:

Full time

Employee Type:

Staff

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About University of Miami

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The University of Miami, located in the beautiful Coral Gables, Florida, is a comprehensive, private research institution in the United States. Operating within the higher education industry, the institution offers a multitude of degree programs spanning over 180 majors and program through its 12 colleges. The University was founded in 1925 with the mission to disseminate knowledge, transform lives, and change the world - a mission it has held faithfully to this day. Notably, the University of Miami has gained global recognition for its commitment to research and innovation, with over $324 million in research and sponsored project funding awarded annually.

Industry

Colleges, universities, and professional schools

Company size

10,000+ Employees

Headquarters location

Coral Gables, FL, US

Year founded

1925

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