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Remote Optum Prior Authorization Jobs in Santa Rosa, CA

Bilingual in English/Spanish and prior Ambassador experience desirable. * BSN preferred ... authorization to work in the US without the need for sponsorship. #LI-CES #LI-REMOTE IQVIA is a ...

Bilingual in English/Spanish and prior Ambassador experience desirable. * BSN preferred ... authorization to work in the US without the need for sponsorship. #LI-CES #LI-REMOTE IQVIA is a ...

Bilingual in English/Spanish and prior Ambassador experience desirable. * BSN preferred ... authorization to work in the US without the need for sponsorship. #LI-CES #LI-REMOTE IQVIA is a ...

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 Santa Rosa, CA?

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

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

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

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

Cities near Santa Rosa, CA with the most Remote Optum Prior Authorization job openings:

Dedicated Remote Mental Health Counselor (LCSW, LMFT, LPCC) Opportunity

Pacific Psychological Services

Santa Rosa, CA • Remote

Full-time

Medical, Retirement, PTO

Posted 5 days ago


Job description

Position Overview

We are seeking a compassionate and skilled Mental Health Counselor, licensed as an LCSW, LMFT, or LPCC, to join our dynamic team at Pacific Psychological Services. This full-time remote position offers an opportunity to deliver impactful therapeutic services to our clients through a telehealth platform. With a competitive salary range of USD 120,000 to 130,000 per year, you will have the flexibility to create your own schedule and provide invaluable support to individuals and families in need.

About the Organization

Pacific Psychological Services is renowned for its commitment to delivering high-quality mental health care through innovative telehealth solutions. Located in Santa Rosa, California, our organization prioritizes client-centered care and fosters a collaborative environment among our dedicated mental health professionals. We strive to ensure that every client receives the attention and support necessary for their mental well-being.

Work Environment

This position is fully remote, allowing our team members to work from the comfort of their own homes while maintaining the highest standards of professionalism and care. Utilizing cutting-edge telecommunication tools such as Google Suite and Electronic Health Records (EHRs), you will connect with clients in a flexible and efficient manner. Our proactive approach to remote work ensures you have the resources and support necessary to excel in your role without any on-call obligations.

Key Responsibilities
  • Conduct comprehensive virtual assessments and screenings to evaluate clients' mental health and substance abuse histories.
  • Facilitate individual and group therapy sessions, employing evidence-based therapeutic modalities tailored to the needs of each client.
  • Collaborate closely with a dedicated treatment team to ensure continuity of care, discussing client progress and adjusting treatment plans as necessary.
  • Maintain meticulous and timely records to comply with regulatory standards and organizational policies.
  • Educate and support clients' families, engaging them in the therapeutic process to enhance recovery outcomes.
Patient Population / Client Focus

We serve a diverse clientele, primarily comprising adolescents and young adults with pre-screened, stable conditions that can be effectively managed through teletherapy. Our low-acuity client demographic allows our therapists to focus on delivering significant therapeutic interventions that foster long-term recovery and mental well-being.

Qualifications
  • A Master's degree in Social Work, Counseling, Marriage and Family Therapy, or Psychology.
  • Active state licensure as an LCSW, LMFT, or LPCC, ensuring you are authorized to practice in the respective jurisdiction.
  • Minimum of 2-3 years of professional experience in providing evidence-based therapeutic interventions, demonstrating a strong foundation in mental health care practices.
  • Advanced proficiency in computer systems, including telehealth platforms, EHR systems, and Google Suite applications.
  • Exceptional written and verbal communication skills, enabling effective interaction with clients, families, and colleagues alike.
Preferred Experience
  • Prior experience delivering telehealth services, particularly to adolescent and young adult populations, will be highly regarded.
  • Demonstrated willingness to engage in training on our organization’s proprietary treatment frameworks, referred to as care pathways, to ensure consistency and quality in therapy delivery.
Compensation and Benefits

As a valued member of our team, you will receive a competitive annual salary ranging from USD 120,000 to 130,000, commensurate with experience. Our comprehensive benefits package includes health insurance options tailored through our partnership with Stride Health, a retirement plan, paid time off, and support for professional development, including continuing education opportunities.

Career Growth Opportunities

At Pacific Psychological Services, we believe in fostering the professional growth of our team members. You will have access to continual learning opportunities, mentorship programs, and a clear path for advancement within the organization as you gain experience and expertise. We are committed to helping our therapists develop their skills and careers in impactful ways.

Why Join Our Team

By joining our dedicated team of mental health professionals, you will not only be contributing to the well-being of individuals, couples, and families, but you will also be part of an inclusive organization that values diversity and equity. We recognize that varied perspectives enhance creativity and problem-solving, and we encourage all qualified candidates to apply, even if their experiences may not exactly match our requirements.

Application Information

If you are ready to make a meaningful difference in the lives of clients and want to contribute to an organization that prioritizes high-quality mental health care, we would love to hear from you. Please submit your application, including your resume and a cover letter detailing your relevant experience, to join our team of professionals dedicated to transforming lives through mental health support.