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 ...
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 ...
Perform clinical reviews of dental claims and prior authorization requests across all lines of ... Collect, evaluate, and analyze data related to grievance, peer review, public policy, and ...
Perform clinical reviews of dental claims and prior authorization requests across all lines of ... Collect, evaluate, and analyze data related to grievance, peer review, public policy, and ...
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 ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Sacramento, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Fresno, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Fresno, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Francisco, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Francisco, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Jose, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Bakersfield, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
Bakersfield, CA · Remote
$30.37 - $59.21/hr
Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant ...
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 ...
Emeryville, CA · On-site +1
$53.12 - $66.18/hr
... authorizations, and the revenue cycle. * Resolve Claims Manager and Epic edits through ... Analyze complex coding data, identify revenue cycle trends, and prepare reports for leadership.
Emeryville, CA · On-site +1
$53.12 - $66.18/hr
... authorizations, and the revenue cycle. * Resolve Claims Manager and Epic edits through ... Analyze complex coding data, identify revenue cycle trends, and prepare reports for leadership.
Sacramento, CA · Remote
$29 - $52/hr
Although this position is remote, applicants must be located in Pacific or Mountain Time Zones ... Function is responsible for utilization management which includes Prior Authorization Review of ...
Sacramento, CA · Remote
$29 - $52/hr
Although this position is remote, applicants must be located in Pacific or Mountain Time Zones ... Function is responsible for utilization management which includes Prior Authorization Review of ...
Sacramento, CA · On-site +1
$29 - $52/hr
Although this position is remote, applicants must be located in Pacific or Mountain Time Zones If ... Function is responsible for utilization management which includes Prior Authorization Review of ...
Sacramento, CA · On-site +1
$29 - $52/hr
Although this position is remote, applicants must be located in Pacific or Mountain Time Zones If ... Function is responsible for utilization management which includes Prior Authorization Review of ...
Hayward, CA · On-site +1
$20 - $24/hr
Excellent analytical, organizational, and problem-solving skills. * Strong verbal and written ... Knowledge of prior authorization and appeals processes. * Experience with multi-specialty or high ...
Hayward, CA · On-site +1
$20 - $24/hr
Excellent analytical, organizational, and problem-solving skills. * Strong verbal and written ... Knowledge of prior authorization and appeals processes. * Experience with multi-specialty or high ...
| 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:
San Jose, CA • Remote
$30.37 - $59.21/hr
Full-time
Re-posted 3 days ago
8.0
Based on 199 frontline employees who took The Breakroom Quiz
172nd of 315 rated insurance
JOB DESCRIPTION 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).
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred.
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: $30.37 - $59.21 / 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
