Orlando, FL · 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 ...
Orlando, FL · 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 ...
Saint Petersburg, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Saint Petersburg, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Boca Raton, FL · On-site +1
$18.25 - $24.75/hr
... representatives to resolve billing issues. * Collaborate with intake, prior authorization, cash ... Remote with limited travel to client locations, internal business meetings, and other locations as ...
Boca Raton, FL · On-site +1
$18.25 - $24.75/hr
... representatives to resolve billing issues. * Collaborate with intake, prior authorization, cash ... Remote with limited travel to client locations, internal business meetings, and other locations as ...
Hollywood, FL · Remote
$35/hr
Follow brand guidelines and occasional scripts or prompts provided by our team. * Use your ... As a UGC Creator, you'll have the freedom to express your creativity , grow your portfolio, and ...
Quick apply
Hollywood, FL · Remote
$35/hr
Follow brand guidelines and occasional scripts or prompts provided by our team. * Use your ... As a UGC Creator, you'll have the freedom to express your creativity , grow your portfolio, and ...
Saint Petersburg, FL · 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 ...
Saint Petersburg, FL · 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 ...
Orlando, FL · 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 ...
Orlando, FL · 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 ...
Jacksonville, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Jacksonville, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Tampa, FL · 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 ...
Tampa, FL · 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 ...
Jacksonville, FL · 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 ...
Jacksonville, FL · 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 ...
Miami, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Miami, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Orlando, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Orlando, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Tampa, FL · 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 ...
Tampa, FL · 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 ...
Miami, FL · 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 ...
Miami, FL · 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 ...
Boca Raton, FL · Remote
$18.25 - $24.75/hr
... representatives to resolve billing issues. * Collaborate with intake, prior authorization, cash ... Remote with limited travel to client locations, internal business meetings, and other locations as ...
Boca Raton, FL · Remote
$18.25 - $24.75/hr
... representatives to resolve billing issues. * Collaborate with intake, prior authorization, cash ... Remote with limited travel to client locations, internal business meetings, and other locations as ...
Jacksonville, FL · 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 ...
Jacksonville, FL · 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 ...
Miami, FL · 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 ...
Miami, FL · 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 ...
Tampa, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Tampa, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Miami, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Miami, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Orlando, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Orlando, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Saint Petersburg, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
Saint Petersburg, FL · Remote
$26.41 - $51.49/hr
Required Qualifications • At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant ...
| Aspect | Remote Prior Authorization Representative Express Scripts | Remote Claims Processor |
|---|---|---|
| Credentials | High school diploma, healthcare certifications often preferred | High school diploma, healthcare or insurance certifications |
| Work Environment | Remote, healthcare insurance setting | Remote, insurance claims processing environment |
| Employer & Industry | Express Scripts, healthcare/pharmacy industry | Various insurance companies, healthcare industry |
| Primary Responsibilities | Review and approve prior authorization requests | Review 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.
The most popular types of Prior Authorization Representative Express Scripts jobs in Florida are:
For Remote Prior Authorization Representative Express Scripts jobs in Florida, the most frequently searched job titles are:
The top searched job categories for Remote Prior Authorization Representative Express Scripts jobs in Florida are:
Cities in Florida with the most Remote Prior Authorization Representative Express Scripts job openings:
Orlando, FL • Remote
$26.41 - $51.49/hr
Full-time
Posted 24 days ago
8.0
Based on 199 frontline employees who took The Breakroom Quiz
164th of 308 rated insurance
Job Summary
Provides support for member services review assessment activities for a specific area of specialty. Responsible for ensuring that services are medically necessary, align with established clinical guidelines, insurance policies, and regulations, and that members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Must reside in Florida.
Essential Job Duties
Analyzes clinical service requests from members and 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, and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes member referrals to other clinical programs as appropriate.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to applicable utilization management policies and procedures.
Required Qualifications
At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant education and experience.
Occupational Therapist (OT), Physical Therapist (PT), Speech-Language Pathologist (SLP). 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.
Excellent verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
#PJHS3
#LI-AC1
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.
Get the full story on Breakroom
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.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
