Long Beach, CA · Remote
$26.41 - $51.49/hr
The ideal candidate will have experience with UM and prior authorization with both inpatient and ... Remote position, must reside in Arizona. Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time ...
Long Beach, CA · Remote
$26.41 - $51.49/hr
The ideal candidate will have experience with UM and prior authorization with both inpatient and ... Remote position, must reside in Arizona. Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time ...
San Mateo, CA · Remote
$140K - $160K/yr
Remote Duration: 3 months We are seeking an experienced Epic Willow Analyst to support a new Epic ... Configure routing rules for e-prescribing, prior authorizations, specialty pharmacy, and retail ...
San Mateo, CA · Remote
$140K - $160K/yr
Remote Duration: 3 months We are seeking an experienced Epic Willow Analyst to support a new Epic ... Configure routing rules for e-prescribing, prior authorizations, specialty pharmacy, and retail ...
Monterey Park, CA · On-site +1
$275K - $325K/yr
Monitor and analyze prior authorization and UM metrics (e.g., denial rates, turnaround times ... This position is fully remote, with some travel to SoCal required as needed. Candidates must have a ...
Monterey Park, CA · On-site +1
$275K - $325K/yr
Monitor and analyze prior authorization and UM metrics (e.g., denial rates, turnaround times ... This position is fully remote, with some travel to SoCal required as needed. Candidates must have a ...
San Francisco, CA · On-site +1
$220K - $300K/yr
Remote Industry: Health tech / AI Compensation: $110K-$150K base, $220K-$300K OTE About the Company Our partner is a seed-stage health-tech company using agentic AI to solve prior authorization for ...
San Francisco, CA · On-site +1
$220K - $300K/yr
Remote Industry: Health tech / AI Compensation: $110K-$150K base, $220K-$300K OTE About the Company Our partner is a seed-stage health-tech company using agentic AI to solve prior authorization for ...
... authorization referral requests. Under general supervision, this position is responsible for ... As a remote employee, we will provide you with the equipment needed to work from home, including a ...
... authorization referral requests. Under general supervision, this position is responsible for ... As a remote employee, we will provide you with the equipment needed to work from home, including a ...
Rancho Cordova, CA · On-site +1
$53.46 - $79.52/hr
... authorization referral requests. Under general supervision, this position is responsible for ... As a remote employee, we will provide you with the equipment needed to work from home, including a ...
Rancho Cordova, CA · On-site +1
$53.46 - $79.52/hr
... authorization referral requests. Under general supervision, this position is responsible for ... As a remote employee, we will provide you with the equipment needed to work from home, including a ...
San Francisco, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
San Francisco, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Long Beach, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Long Beach, CA · Remote
$30.37 - $59.21/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Pharmacy Prior Authorization & Specialty-Medication Access Specialist Type: Contract Compensation: $75/hour Location: Remote Role Responsibilities * Process and manage prior authorisation requests ...
Quick apply
Pharmacy Prior Authorization & Specialty-Medication Access Specialist Type: Contract Compensation: $75/hour Location: Remote Role Responsibilities * Process and manage prior authorisation requests ...
Los Angeles, CA · On-site +1
$85K - $120K/yr
Role Overview Manta is building the operational backbone for prior authorization management in ... Lead root-cause analysis on errors or client-impacting issues Product Partnership * Translate ...
Los Angeles, CA · On-site +1
$85K - $120K/yr
Role Overview Manta is building the operational backbone for prior authorization management in ... Lead root-cause analysis on errors or client-impacting issues Product Partnership * Translate ...
$74 - $82/hr
This fully remote opportunity offers a consistent 20-hour-per-week schedule , allowing experienced ... Review dental claims, referrals, and prior authorization requests across multiple lines of business.
$74 - $82/hr
This fully remote opportunity offers a consistent 20-hour-per-week schedule , allowing experienced ... Review dental claims, referrals, and prior authorization requests across multiple lines of business.
Long Beach, CA · Remote
$26.41 - $43/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Long Beach, CA · Remote
$26.41 - $43/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs ...
Long Beach, CA · Remote
$26.41 - $51.49/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors, and ...
Long Beach, CA · Remote
$26.41 - $51.49/hr
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors, and ...
Pleasanton, CA · On-site +1
Hello, We are looking for Automation Analyst for one of our clients in Pleasanton, California . If ... Work Authorization: Relocation (Yes/No): Skype: DOB(MM/DD): Thanks & Best Regards Mohammed Imran ...
Pleasanton, CA · On-site +1
Hello, We are looking for Automation Analyst for one of our clients in Pleasanton, California . If ... Work Authorization: Relocation (Yes/No): Skype: DOB(MM/DD): Thanks & Best Regards Mohammed Imran ...
Long Beach, CA · On-site +1
Hello , We are looking for Data Analyst for one of our clients in Long Beach, California . If you ... Work Authorization copy: DL COPY: Education Details(Bachelor's & Masters' With Year Of Passing)
Long Beach, CA · On-site +1
Hello , We are looking for Data Analyst for one of our clients in Long Beach, California . If you ... Work Authorization copy: DL COPY: Education Details(Bachelor's & Masters' With Year Of Passing)
San Jose, CA · Remote
$100 - $200/hr
Remote Job Overview We are seeking experienced AI Consulting Domain Experts to contribute their ... No prior AI experience is required--your consulting expertise, analytical thinking, and ...
Quick apply
San Jose, CA · Remote
$100 - $200/hr
Remote Job Overview We are seeking experienced AI Consulting Domain Experts to contribute their ... No prior AI experience is required--your consulting expertise, analytical thinking, and ...
| Aspect | Remote Prior Authorization Analyst | Remote Claims Processor |
|---|---|---|
| Required Credentials | Healthcare certifications, knowledge of insurance policies | Basic insurance knowledge, data entry skills |
| Work Environment | Home office, healthcare or insurance companies | Home office, insurance companies or third-party administrators |
| Employer & Industry | Hospitals, insurance providers, healthcare organizations | Insurance companies, third-party claims firms |
| Common Search/Comparison | Yes | Yes |
The Remote Prior Authorization Analyst and Remote Claims Processor roles both operate in the healthcare insurance industry and often require knowledge of insurance policies. However, the analyst focuses on obtaining prior approvals for treatments, while the claims processor handles the processing of insurance claims after services are rendered. Both roles are typically remote, involve working within healthcare or insurance organizations, and are frequently compared by job seekers seeking similar positions in the industry.
The most popular types of Prior Authorization Analyst jobs in California are:
For Remote Prior Authorization Analyst jobs in California, the most frequently searched job titles are:
The top searched job categories for Remote Prior Authorization Analyst jobs in California are:
Cities in California with the most Remote Prior Authorization Analyst job openings:
$26.41 - $51.49/hr
Full-time
Posted 26 days ago
8.0
Based on 199 frontline employees who took The Breakroom Quiz
164th of 308 rated insurance
JOB DESCRIPTION
This position will support the Arizona state Plan. We are seeking a candidate with an Arizona RN licensure. The ideal candidate will have experience with UM and prior authorization with both inpatient and outpatient. Candidates with a Behavioral Health background are highly preferred. Further details to be discussed during our interview process. Prefers candidates with 3 years of experience.
Remote position, must reside in Arizona.
Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time with some weekends and holidays.
Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.
Required Qualifications
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $26.41 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
