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Remote Optum Prior Authorization Jobs (NOW HIRING)

WELLDYNE

Prior Authorization Technician II

$28K - $40K/yr

Prior Authorization Technician II This position is fully remote. The required working schedule is 8:00 AM - 5:00 PM Mountain Time (MST) or 10:00 AM - 7:00 PM Eastern Time (EST) , depending on ...

WellDyne

Prior Authorization Technician II

$18 - $21.75/hr

Prior Authorization Technician II This position is fully remote. The required working schedule is 8:00 AM - 5:00 PM Mountain Time (MST) or 10:00 AM - 7:00 PM Eastern Time (EST) , depending on ...

Insight Global

Remote Prior Authorization Pharmacist

OR · Remote

$59/hr

The Pharmacist, Prior Authorization (PA) & Appeals, is responsible for reviewing and evaluating prior authorization and appeals requests to determine coverage based on clinical guidelines, pharmacy ...

New

PainPoint

Prior Authorization Team Lead

Thrive in a collaborative remote environment. Qualifications * High School Diploma or GED required. * At least one (1) year of prior authorization experience in a clinical setting required.

ICONMA

Prior Authorization Clinician

Our Client, a Medical Center company, is looking for a Prior Authorization Clinician for their Remote location. Responsibilities: * Determines medical appropriateness of inpatient and outpatient ...

PainPoint

Prior Authorization Team Lead

Atlanta, GA · On-site +1

$23/hr

Prior Authorization Team Lead Full-Time | Remote | $23/hr Schedule: Monday-Friday 8:00 AM-4:30 PM About DxTx DxTx Pain & Spine is a physician-aligned partner organization dedicated to supporting ...

PainPoint

Prior Authorization Team Lead

$23/hr

Prior Authorization Team Lead Full-Time | Remote | $23/hr Schedule: Monday-Friday 8:00 AM-4:30 PM About DxTx DxTx Pain & Spine is a physician-aligned partner organization dedicated to supporting ...

A-Line Staffing Solutions

Be Seen First

REMOTE Pharmacy Technician/Prior Authorization

Tampa, FL · Remote

$20 - $21/hr

A-Line Staffing is actively searching for Multiple REMOTE Pharmacy Techs/Prior Authorization reps for a major healthcare company located anywhere in the United States surrounding area. This is an ...

US Tech Solutions

Pharmacist - Prior Authorization #

$59.50 - $71.75/hr

Remote Duration: 12+ Months As a Clinical Pharmacist Advisor Medicare, you will be directly ... Prior Authorization Pharmacy Benefit Management Medicare Part D Education: Bachelor's degree in ...

CVS Health

Clinical Pharmacist - Prior Authorization

$50.48 - $84.62/hr

This is a remote role open to candidates within the United States. Required Qualifications 2 years ... Current experience working with commercial Prior Authorizations within Caremark PBM Experience ...

Onco360

Pharmacy Prior Authorization Specialist

Waltham, MA · On-site +1

$22.25 - $29/hr

Remote work possible after initial on-site training. Why Join Us? * A career with purpose: Help ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

Onco360

Pharmacy Prior Authorization Specialist

Woodridge, IL · On-site +1

$20.25 - $26.25/hr

Remote work possible after initial on-site training. Why Join Us? * A career with purpose: Help ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

Onco360

Pharmacy Prior Authorization Specialist

Louisville, KY · On-site +1

$18.75 - $24.25/hr

Remote work possible after initial on-site training. Why Join Us? * A career with purpose: Help ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

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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.

More about Remote Optum Prior Authorization jobs

What cities are hiring for Remote Optum Prior Authorization jobs?

Cities with the most Remote Optum Prior Authorization job openings:

What are the most commonly searched types of Optum Prior Authorization jobs?

The most popular types of Optum Prior Authorization jobs are:

What states have the most Remote Optum Prior Authorization jobs?

States with the most job openings for Remote Optum Prior Authorization jobs include:

What are popular job titles related to Remote Optum Prior Authorization jobs?

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

Remote Optum Prior Authorization jobs near you
Infographic showing various Remote Optum Prior Authorization job openings in the United States as of September 2026, with employment types broken down into 73% Full Time, 9% Part Time, and 18% Contract. Highlights an 100% Remote job distribution.

Prior Authorization Technician II

Remote

WELLDYNE
Health Care and Social Assistance • 501 - 1,000 employees
Learn more about WELLDYNEexternal

$28K - $40K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 20 days ago

WellDyne rating

5.5

Company rating: 5.5 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

Job description

Prior Authorization Technician II
This position is fully remote. The required working schedule is 8:00 AM - 5:00 PM Mountain Time (MST) or 10:00 AM - 7:00 PM Eastern Time (EST), depending on business needs and your time zone.
Summary
The Prior Authorization Tech II is responsible for starting all clinical prior authorization requests via telephone or email, which includes creating and faxing cases for prior authorization while maintaining complete, timely and accurate documentation of all requests. Individuals will also complete PA requests via telephone with appropriate staff at the prescriber's office. Individuals also work closely with pharmacies, providers, and members to resolve any questions or issues involving prior authorizations while maintaining confidentiality of all PHI. This position requires strong telephone, verbal and written communication skills, knowledge of customer service principles and practices, and time management skills with the ability to multi-task. Individuals must also be proficient in Microsoft applications.
Essential Duties and Responsibilities
  • Responsible for starting clinical prior authorization requests via telephone or email.
  • Support prior authorization call center via administrative and clinical prior authorization support lines.
  • Creates and faxes cases for prior authorization, maintaining complete, timely and accurate documentation of all prior authorization requests.
  • Completes prior authorization request via telephone with appropriate staff at prescriber's office by answering questions based on protocols when possible.
  • Works closely with pharmacies, providers, and members to resolve any questions or issues involving prior authorizations.
  • Responds in a prompt, professional, and courteous manner to pharmacy, provider and member inquiries regarding administrative prior authorizations.
  • Ability to clearly identify problems, analyze situations, and rectify pharmacy, provider, or member concerns using established procedures.
  • Ability to handle difficult people and problems by resolving matters in an effective and timely manner.
  • Responsible for clearing and following up on all messages left on prior authorization voicemail box in a timely manner.
  • Apply appropriate policies, procedures, and eligibility and benefit policies.
  • Maintains confidentiality of all PHI in compliance with state and federal law.
  • Consistently meets established productivity, schedule adherence, and quality standards, while maintaining a good attendance record.
  • Other duties as assigned.

Education and Experience
  • Pharmacy Technician Certification strongly preferred or must be committed to obtaining PTCB Certification within 6 months of position start date
  • Technician registration that is active and in good-standing, as applicable based upon state requirements for technicians
  • At least 2 years of pharmacy related experience
  • At least 2 years of customer service-related experience
  • MS Office Suite knowledge (Which includes the ability to learn new and complex computer system applications)

Knowledge, Skills, and Abilities
  • Strong telephone, verbal, and written communication skills
  • Knowledge of customer service principles and practices
  • Time Management Skills
  • Teamwork and team building skills
  • Ability to work independently within a team environment with little direct supervision
  • Ability to work in a high pace, stress environment
  • Ability to remain focused and productive each day though tasks may be repetitive
  • Strong attention to detail and effective follow-up skills
  • Ability to multi-task
  • Claim system knowledge
  • Positive attitude with excellent customer service mindset demonstrating WellDyneRx commitment to incredible service
  • Computer proficiency to navigate required databases and operate in required software packages
  • Working with people with a strong desire to help resolve problems
  • Ability to work under pressure
  • Creative problem solver and effective at conflict resolution
  • Ability to sit at a computer using a phone and headset for length of shift with breaks and lunch away from desk assigned per length of given shift
  • Demonstrated ability to handle problems tactfully

Remote Work Requirements
  • To ensure effective performance in a remote environment, all candidates must meet the following technical and workspace requirements:
  • Internet Speed: Minimum of 100 Mbps download / 10 Mbps upload, verified by HR through a speed test
  • Connectivity: Must be able to connect using a hard-wired Ethernet connection (modem/router must be within 10 feet to allow for a wired setup)
  • Phone Access: A mobile device is required to receive VPN push notifications and for system support
  • Workspace: A dedicated, quiet workspace that minimizes background noise and distractions

WellDyne Can Offer You
  • Medical, Dental and Vision Benefits
  • Medical Savings Account Options with Company match
  • 401K after 90 days of employment
  • Employee Assistance Program
  • Life and Supplemental insurance
  • Educational Reimbursement
  • Paid Time Off
  • Career Pathing

Base Salary Range: $28,700-$40,900
In accordance with applicable state and federal laws, the range provided is WellDyne's reasonable estimate of the base compensation for this role. The actual amount may differ based on non-discriminatory factors such as experience, knowledge, skills, abilities, and location. Base pay is one part of the total package that is provided to compensate and recognize employees for their work, and this role may be eligible for additional discretionary bonuses/incentives, and equity in the Company.
Work Environment / Physical Demands
This position is in a typical office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.
EOE M/F/D/V

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