ZipRecruiter

Log In

2

Remote Optum Prior Authorization Jobs in Merced, CA

All JobsOptum Prior Authorization JobsRemote Optum Prior Authorization JobsRemote Optum Prior Authorization Jobs in Merced, CA

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 popular job titles related to Remote Optum Prior Authorization jobs in Merced, CA?

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

What job categories do people searching Remote Optum Prior Authorization jobs in Merced, CA look for?

The top searched job categories for Remote Optum Prior Authorization jobs in Merced, CA are:

What cities near Merced, CA are hiring for Remote Optum Prior Authorization jobs?

Cities near Merced, CA 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 Merced, CA as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 1% Temporary, and 3% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Field Remote Provider Engagement Specialist Merced/Stanislaus County

Alignment Healthcare

Merced, CA • Remote

$58K - $87K/yr

Full-time

Posted 7 days ago

Alignment Healthcare rating

7.3

Company rating: 7.3 out of 10

Based on 17 frontline employees who took The Breakroom Quiz

236th of 306 rated insurance

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Health is seeking a proactive, relationship-driven, and highly organized Provider Engagement Specialist to support our growing provider network inMerced/Stanislaus County, CA.In this field-based remote role, you will build strong relationships with physician practices and provider groups, helping improve quality, growth, retention, utilization, and risk adjustment performance while supporting network expansion.
This position is ideal for a self-driven professional who enjoys building partnerships, analyzing provider performance, solving problems, and improving healthcare outcomes.
Key Highlights
  • Field-based role with approximately 80% travel throughoutMerced/Stanislaus County, CA .
  • Flexible, self-managed schedule
  • Initial training may include shadowing an established market team in Raleigh, NC
  • Occasional travel (1-2 times annually) for meetings, training, or conferences
  • Mileage and travel expenses reimbursed per company policy
  • Primarily Monday-Friday during provider office hours, with flexibility for occasional early morning, evening, or community events
Essential Duties & Responsibilities
  • Build and maintain collaborative relationships with providers and office staff.
  • Partner with providers to improve performance in growth, retention, AWVs, HEDIS gap closures, hospital and ER utilization, risk adjustment, and other quality metrics.
  • Conduct provider onboarding and ongoing education regarding Alignment Health tools, programs, incentives, member benefits, Model of Care requirements, compliance requirements, and organizational initiatives.
  • Develop provider training materials, implementation packets, and educational presentations.
  • Serve as the primary point of contact for provider issues, including UM, prior authorizations, claims, eligibility, encounter data, provider rosters, and directory validation.
  • Represent Alignment Health at provider meetings, trainings, and community events.
  • Negotiate and implement physician and ancillary agreements and support provider credentialing and recruitment efforts.
  • Maintain provider engagement documentation, tracking databases, activity reports, and meeting records.
  • Attend staff meetings and perform special projects as assigned.
Qualifications
Education
  • Bachelor's degree (B.A. or B.S.) preferred; or equivalent combination of education and experience.
Experience
  • Minimum of two (2) years of related experience and/or training.
  • Experience in provider relations, provider contracting, network development, healthcare operations, managed care, IPA, HMO, medical group, or institutional provider environments required.
Preferred Qualifications
  • Bilingual English/Spanish preferred.
  • Experience working directly with physician practices and healthcare providers.
  • Knowledge of Medicare Advantage, quality programs, risk adjustment, utilization management, and provider performance metrics.
Knowledge, Skills, and Abilities
  • Strong relationship-building and interpersonal skills.
  • Excellent verbal and written communication abilities.
  • Strong presentation and facilitation skills.
  • Strong analytical, quantitative, and problem-solving capabilities.
  • Highly organized, detail-oriented, and self-motivated.
  • Ability to work independently and collaboratively.
  • Ability to effectively engage diverse provider audiences.
  • Proficiency with Microsoft Office Suite (Word, Excel, and PowerPoint).
Travel Requirements
  • Routinely required to travel by car throughout the assigned market (80% or more).
  • Must maintain reliable transportation, a valid driver's license, and automobile insurance.
  • Air travel required as needed.
  • Extended or flexible work hours may occasionally be required.
Work Environment
This position is primarily field-based and requires regular travel to provider offices throughout theMerced/Stanislaus County, CAmarket. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.
Why Join Alignment Health?
Join a growing organization where you'll help strengthen provider partnerships, improve healthcare outcomes, and support the success of a new and expanding market while making a meaningful impact on the communities we serve.
Pay Range: $58,531.00 - $87,797.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER:Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information.Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company.If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission athttps://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please emailcareers@ahcusa.com.

What Alignment Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply