Saint Petersburg, FL · Remote
$26.41 - $43/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 ...
Saint Petersburg, FL · Remote
$26.41 - $43/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 ...
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 ...
Miami, FL · Remote
$26.41 - $43/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 ...
Miami, FL · Remote
$26.41 - $43/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 ...
Jacksonville, FL · Remote
$26.41 - $43/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 ...
Jacksonville, FL · Remote
$26.41 - $43/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 ...
Jacksonville, FL · Remote
$26.41 - $43/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 ...
Jacksonville, FL · Remote
$26.41 - $43/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 ...
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 ...
Orlando, FL · Remote
$26.41 - $43/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 ...
Orlando, FL · Remote
$26.41 - $43/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 ...
Fort Lauderdale, FL · Remote
$26.41 - $43/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 ...
Fort Lauderdale, FL · Remote
$26.41 - $43/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 ...
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 ...
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 ...
Tampa, FL · Remote
You'll use a powerful selling script to convert these leads into satisfied customers. With a robust ... Fully Remote.
Tampa, FL · Remote
You'll use a powerful selling script to convert these leads into satisfied customers. With a robust ... Fully Remote.
... remote flexibility. At InsuraTec , we equip you with warm inbound leads , step-by-step scripts, and ... Sales Representative at InsuraTec. #ZR Company Description InsuraTec is a relentless group of ...
Quick apply
... remote flexibility. At InsuraTec , we equip you with warm inbound leads , step-by-step scripts, and ... Sales Representative at InsuraTec. #ZR Company Description InsuraTec is a relentless group of ...
... remote flexibility. At InsuraTec , we equip you with warm inbound leads , step-by-step scripts, and ... Sales Representative at InsuraTec. #ZR Company Description InsuraTec is a relentless group of ...
Quick apply
... remote flexibility. At InsuraTec , we equip you with warm inbound leads , step-by-step scripts, and ... Sales Representative at InsuraTec. #ZR Company Description InsuraTec is a relentless group of ...
... remote flexibility. At InsuraTec , we equip you with warm inbound leads , step-by-step scripts, and ... Sales Representative at InsuraTec. #ZR Company Description InsuraTec is a relentless group of ...
Quick apply
... remote flexibility. At InsuraTec , we equip you with warm inbound leads , step-by-step scripts, and ... Sales Representative at InsuraTec. #ZR Company Description InsuraTec is a relentless group of ...
... remote flexibility. At InsuraTec , we equip you with warm inbound leads , step-by-step scripts, and ... Sales Representative at InsuraTec. #ZR Company Description InsuraTec is a relentless group of ...
Quick apply
... remote flexibility. At InsuraTec , we equip you with warm inbound leads , step-by-step scripts, and ... Sales Representative at InsuraTec. #ZR Company Description InsuraTec is a relentless group of ...
Tampa, FL · Remote
$65K - $125K/yr
As an Inside Sales Representative (Closer), you will play a pivotal role in driving new business ... Following a proven sales process and scripts to qualify prospects, handle objections, and secure ...
Tampa, FL · Remote
$65K - $125K/yr
As an Inside Sales Representative (Closer), you will play a pivotal role in driving new business ... Following a proven sales process and scripts to qualify prospects, handle objections, and secure ...
Jacksonville, FL · On-site +1
No prior financial experience is necessary-we provide the tools and resources to help you succeed ... Flexible schedule with remote and in-person work options. * Full benefits package: health, dental ...
Jacksonville, FL · On-site +1
No prior financial experience is necessary-we provide the tools and resources to help you succeed ... Flexible schedule with remote and in-person work options. * Full benefits package: health, dental ...
Sarasota, FL · Remote
$65K - $125K/yr
As an Inside Sales Representative (Closer), you will play a pivotal role in driving new business ... Following a proven sales process and scripts to qualify prospects, handle objections, and secure ...
Sarasota, FL · Remote
$65K - $125K/yr
As an Inside Sales Representative (Closer), you will play a pivotal role in driving new business ... Following a proven sales process and scripts to qualify prospects, handle objections, and secure ...
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 ...
| 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.
$26.41 - $43/hr
Full-time
This job post has expired today. Applications are no longer accepted.
8.0
Based on 199 frontline employees who took The Breakroom Quiz
163rd of 304 rated insurance
JOB DESCRIPTION
Must reside in Florida
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.
#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 - $43 / 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
