ZipRecruiter

Log In

2

Remote Prior Authorization Jobs (NOW HIRING)

CVS Health

Prior Authorization UM Nurse Consultant

Utilization Management Nurse Consultant (RN) Remote | Prior Authorization | Louisiana Medicaid Preferred Are you an experienced RN with a background in Utilization Management and Prior Authorization?

PharMerica

Prior Authorization Specialist

Louisville, KY · On-site +1

$16.50 - $22/hr

Mon-Fri(8:30am to 5pm) This is not a remote opportunity . Applicants must reside in, or commutable ... The Prior Authorization Coordinator is responsible for striving to complete either approval for ...

Amerita

Prior Authorization Specialist

Denver, CO · On-site +1

$22/hr

This role requires working knowledge of pharmacy benefits and the prior authorization process. Schedule: Monday - Friday 8 am-5:30 pm MST We Offer: • Competitive Pay • Health, Dental, Vision ...

PharMerica

Prior Authorization Specialist

Louisville, KY · On-site +1

$16.50 - $22/hr

Mon-Fri(8:30am to 5pm) This is not a remote opportunity . Applicants must reside in, or commutable ... The Prior Authorization Coordinator is responsible for striving to complete either approval for ...

CVS Health

Prior Authorization UM Nurse Consultant

Utilization Management Nurse Consultant (RN) Remote | Prior Authorization | Utilization Management Are you an experienced RN with utilization management or prior authorization experience looking to ...

Amerita

Prior Authorization Specialist

Denver, CO · On-site +1

$22 - $30/hr

This role requires working knowledge of pharmacy benefits and the prior authorization process. Schedule:Monday - Friday 8 am-5:30 pm MST We Offer: Competitive Pay Health, Dental, Vision & Life ...

Managed Staffing

Prior Authorization Techician

RI · Remote

$21 - $22/hr

Fully Remote (U.S. based) - West Coast candidates preferred Seeking Pharmacy Technician I (Prior Authorization) professionals to join their remote Caremark team. This role is responsible for ...

OU Medical Center

Prior Authorization Specialist II

$18.50 - $24.50/hr

Prior Authorization Specialist II Department: Pre-visit Services New to OU Health? Ask your ... Remote Eligibility: Candidates must reside and work full-time in OK before their first day of ...

MRIoA

Prior Authorization Pharmacist (Remote)

Salt Lake City, UT · On-site +1

$56.25 - $67.75/hr

An award-winning remote work environment POSITION OVERVIEW The PA Pharmacist is an important member ... To evaluate prior authorizations for drug appropriateness per drug policy criteria * To provide ...

OU Health

Prior Authorization Specialist II

$18.50 - $24.50/hr

Prior Authorization Specialist II Department: Pre-visit Services New to OU Health? Ask your ... Remote Eligibility: Candidates must reside and work full-time in OK before their first day of ...

previous pagenext page

Showing results 21-40

All Jobsremote JobsRemote Prior Authorization Jobs

Remote Prior Authorization information

See salary details

$13

$20

$32

How much do remote prior authorization jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for remote prior authorization in the United States is $20.89, according to ZipRecruiter salary data. Most workers in this role earn between $17.31 and $23.08 per hour, depending on experience, location, and employer.

What is a remote prior authorization job?

Remote prior authorization jobs involve reviewing and processing requests from healthcare providers to determine if specific medical treatments, medications, or procedures are covered by a patient's insurance plan. Employees in these roles work from home, utilizing online systems to evaluate clinical information, communicate with providers, and ensure compliance with insurance policies. This position requires a strong understanding of medical terminology, insurance guidelines, and attention to detail to facilitate timely and accurate approvals or denials. Remote prior authorization specialists help streamline patient care by acting as a liaison between healthcare providers and insurance companies.

What is a remote prior authorization job?

Remote prior authorization jobs focus on working with insurance companies to coordinate benefit coverage and get approval to provide care for a patient. In this pre-authorization role, you may collect documentation and proof of insurance, perform data entry, help evaluate the need for a particular process, and otherwise work from home to help manage the prior authorization process. Remote prior authorization personnel often answer telephone calls to provide consultations, perform initial benefit verification, document case status, actions, and outcomes in a database, and use customer service skills to help expedite cases as needed. Since this is a remote call center-style job, you may be asked to arrange for a quiet office in your house that is free of distractions.

What are the key skills and qualifications needed to thrive as a remote prior authorization specialist, and why are they important?

To thrive as a Remote Prior Authorization Specialist, you need a solid understanding of medical terminology, insurance processes, and healthcare regulations, often supported by experience in medical billing or coding. Familiarity with electronic health record (EHR) systems, insurance portals, and prior authorization software is typically required. Attention to detail, strong organizational skills, and effective communication are crucial soft skills in this role. These skills ensure timely and accurate processing of authorizations, reducing claim denials and supporting efficient patient care.

What are some common challenges faced by remote prior authorization specialists, and how can they be addressed?

Remote Prior Authorization specialists often encounter challenges such as navigating complex insurance requirements, managing high volumes of requests, and maintaining clear communication with healthcare providers and payers. Staying organized and up-to-date on payer policies is crucial, as requirements can vary widely between insurers. Utilizing workflow management tools and fostering strong collaboration with clinical and administrative teams can help streamline processes and reduce delays, ultimately ensuring patients receive timely care.

What is the difference between Remote Prior Authorization vs Remote Medical Coder?

AspectRemote Prior AuthorizationRemote Medical Coder
Required CredentialsMedical credentials, insurance knowledgeMedical coding certification (CPC, CCS)
Work EnvironmentHealthcare offices, insurance companies, remoteHealthcare facilities, remote coding jobs
Industry UsageInsurance, healthcare providersHospitals, clinics, billing companies
Job FocusReviewing and approving insurance requestsTranslating medical records into codes

Remote Prior Authorization and Remote Medical Coder roles both operate within the healthcare industry but focus on different tasks. Remote Prior Authorization involves reviewing insurance requests for coverage approval, requiring insurance and medical knowledge. Remote Medical Coders translate medical records into standardized codes, primarily focusing on billing and documentation. Both roles can be performed remotely and require healthcare-related credentials, but their daily responsibilities and skill sets differ significantly.

Are remote prior authorization jobs in high demand?

Remote prior authorization jobs are in moderate to high demand due to the increasing need for efficient healthcare administration and insurance processing. These roles often require knowledge of healthcare policies, strong communication skills, and familiarity with electronic health record systems. The demand is expected to grow as healthcare providers and insurers continue to prioritize remote and streamlined authorization processes.
More about Remote Prior Authorization jobs

What cities are hiring for Remote Prior Authorization jobs?

Cities with the most Remote Prior Authorization job openings:

What are the most commonly searched types of Prior Authorization jobs?

The most popular types of Prior Authorization jobs are:

What states have the most Remote Prior Authorization jobs?

States with the most job openings for Remote Prior Authorization jobs include:

What job categories do people searching Remote Prior Authorization jobs look for?

The top searched job categories for Remote Prior Authorization jobs are:

Remote Prior Authorization jobs near you
Infographic showing various Remote Prior Authorization job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $43,459 per year, or $20.9 per hour.

Prior Authorization UM Nurse Consultant

CVS Health

Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,364 frontline employees who took The Breakroom Quiz

92nd of 113 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Utilization Management Nurse Consultant (RN)

Remote | Prior Authorization | Louisiana Medicaid Preferred

Are you an experienced RN with a background in Utilization Management and Prior Authorization? Join our team and use your clinical expertise to help ensure members receive appropriate, high-quality, and cost-effective care across a broad range of medical specialties.

What You'll Do

  • Review prior authorization requests and medical records to determine medical necessity
  • Apply evidence-based clinical guidelines, benefit plans, and regulatory requirements to authorization decisions
  • Utilize InterQual, MCG, or similar clinical criteria to support consistent, quality outcomes
  • Collaborate with providers, care managers, medical directors, and interdisciplinary teams
  • Support timely and accurate utilization management decisions while maintaining quality standards
  • Manage a high-volume caseload in a fast-paced, deadline-driven environment
  • Help ensure members receive clinically appropriate care while supporting effective resource utilization

WHAT YOU BRING - REQUIRED

  • Active, unrestricted multi-state Registered Nurse (RN) licensure in the state of residence, or the ability to obtain and maintain multi-state.
  • Ability to obtain and maintain additional state licensure as required
  • 3+ years of clinical nursing experience
  • 2+ years of Utilization Management, Prior Authorization, Managed Care, Case Management, or Clinical Review experience
  • Experience reviewing medical records and determining medical necessity using evidence-based criteria
  • Experience utilizing InterQual, MCG, or similar clinical decision-support tools
  • Strong clinical assessment, critical thinking, and decision-making skills
  • Excellent written and verbal communication skills
  • Ability to manage multiple priorities while meeting productivity and turnaround-time expectations
  • Proficiency with electronic medical records and utilization management platforms

Preferred Qualifications

  • BSN preferred
  • Experience supporting Medicaid, Medicare, or Commercial Health Plan populations
  • Prior Authorization experience within a health plan or managed care organization
  • Experience reviewing inpatient, outpatient, surgical, diagnostic, specialty, and ancillary service requests
  • Knowledge of state and federal utilization management regulations
  • Remote work experience
  • Louisiana residency preferred
  • Experience supporting Louisiana Medicaid populations preferred

Education

  • Associate Degree in Nursing (ASN) required
  • Bachelor of Science in Nursing (BSN) preferred

Why Join Us?

  • Fully remote opportunity
  • Apply your clinical expertise in a non-bedside role
  • Collaborate with providers, medical directors, and care teams
  • Influence healthcare quality and member outcomes
  • Grow your career in Utilization Management and Managed Care

If you're a detail-oriented RN with strong clinical judgment and prior authorization experience, we'd love to hear from you. Apply today!

Work from Home Requirements:

  • You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
  • A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
  • Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
  • The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
  • If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

  • Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
  • Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
  • Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
  • Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
  • Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
  • Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 09/12/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

What CVS Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply