Job Description

Responsibilities:

Review approximately 20 prior authorization (auth) requests daily , Monday-Friday.
Complete all reviews and submit them to the UM Coordinator before 3:00 PM PST .
Evaluate each auth by reviewing:

Member's medical records
Auth request details
Relevant clinical criteria (CMS, Health Plan, InterQual, MCG)

For denied or partially approved requests , provide:

A clear, detailed rationale
Cited criteria including name, title, and number

Monitor your assigned auth queue in the UM system.
Ensure that all auths are reviewed and returned within the assigned turnaround times (TAT), color-coded as:

Red: Past due
Yellow: Nearing deadline
Green: Over 24 hours remaining

Notify the team in advance for scheduled time off ; unreviewed auths must be carried over and completed the following day.
Provide 24-hour notice for unscheduled time off , when possible.
Collaborate with the UM team and follow protocols for criteria application and review submission.

Training Provided:

Training on our Prior Authorization system and workflow
Instruction on how to cite criteria appropriately
Criteria documents will be attached to each auth for your review

Additional Notes:

This is a remote, part-time contract role
Reviewers are expected to consistently meet the 20-auths-per-day quota
Queue monitoring and daily communication with the UM team are essential for success.The pay range for this position at commencement of contract is expected to be between $6,000.00 - $6,000.00 per month.

Active, unrestricted California medical license (MD or DO)
Strong clinical decision-making and documentation skills
Familiarity with CMS guidelines, InterQual, MCG, and major health plan criteria
Ability to work independently and meet strict daily deadlines
Comfortable working with digital systems and remote teams

Job Tags

Contract work, Part time, Monday to Friday,

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