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Remote Prior Authorization Representative Express Scripts Jobs in California

Computer Task Group, Inc

Epic Willow Analyst

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 ...

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Remote Prior Authorization Representative Express Scripts information

What is the difference between Remote Prior Authorization Representative Express Scripts vs Remote Claims Processor?

AspectRemote Prior Authorization Representative Express ScriptsRemote Claims Processor
CredentialsHigh school diploma, healthcare certifications often preferredHigh school diploma, healthcare or insurance certifications
Work EnvironmentRemote, healthcare insurance settingRemote, insurance claims processing environment
Employer & IndustryExpress Scripts, healthcare/pharmacy industryVarious insurance companies, healthcare industry
Primary ResponsibilitiesReview and approve prior authorization requestsReview and process insurance claims

The Remote Prior Authorization Representative at Express Scripts focuses on evaluating and approving prior authorization requests for medications, ensuring timely patient access. In contrast, a Remote Claims Processor handles the review and processing of insurance claims after services are rendered. While both roles require healthcare knowledge and remote work skills, their core functions differ in the stages of the insurance process they manage.

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Remote Prior Authorization Representative Express Scripts jobs near you
Infographic showing various Remote Prior Authorization Representative Express Scripts job openings in California as of June 2026, with employment types broken down into 83% Full Time, 16% Part Time, and 1% Temporary. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

Molina Healthcare

San Diego, CA • Remote

$30.37 - $59.21/hr

Full-time

Posted 16 days ago

Key responsibilities

  • Assesses services for members to ensure optimum outcomes, cost-effectiveness, and compliance with regulations and guidelines.

  • Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

  • Conducts reviews to determine prior authorization and financial responsibility for members.

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

144th of 263 rated insurance

Job description

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.

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

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About Molina Healthcare

Sourced by ZipRecruiter

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.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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