Associate Utilization Review Specialist - Remote

Providence Health & Services; Oregon (WI); Remote; USD 39,137 - 59,884; Full time

Benefits offered by this job

Comprehensive benefits package

401(k) with employer matching

Paid parental leave

Health care benefits

Job summary

A leading healthcare organization is seeking a Prior Authorization Specialist to manage core functions and support care efficiently. This role requires strong critical thinking and experience in healthcare. Primary responsibilities include reviewing medical service requests and providing support over the phone to providers and members. Candidates must have a relevant degree or equivalent experience. This position offers 100% remote work for residents of Washington, Oregon, and California.

Qualifications

• 2 years experience in healthcare or equivalent education.
• Experience researching and resolving complex problems.
• Experience with telephony systems and call center operations.

Responsibilities

• Manage core functions in the Prior Authorization Department.
• Review and assess medical service requests for authorization.
• Provide support via incoming calls from providers and members.

Skills

Critical thinking

Database management

Multiline communication

Problem-solving

Education

Bachelor’s Degree in Health related field

Job description

Description

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient‑focused, whole‑person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Responsibilities

• Be responsible for all core functions in the Prior Authorization (PA) Department
• Coordinate and execute the review and research functions required to support the PA Department
• Investigate, review, and prepare all requests for prior authorization review for all lines of business (LOB) in multiple applications (Facets, CIM, CareAdvance, etc.) while using multiple resources to support the review (Medical Policies, KMS, Benefit Grids, Handbooks, etc.)
• Critically assess and prepare all cases for RN/MD review of coverage (medical necessity, eligibility, network status, regulatory)
• Use appropriate resources and sound judgement to review and approve specific service requests based on deep understanding of medical service requested, CPT/HCPCS codes, and plan design. Authorize select medical services
• Provide research, assessment, and proposed resolution of operational issues as they relate to coverage policy, correct coding (CPT/HCSPCS, Dx), regulations, and other coverage rules
• Take incoming phone calls from providers and members regarding operational plan functions with an ability to research and follow‑up on unique prior authorization related requests and plan processes for all lines of business
• Be responsible for ensuring service review requests and inquiries are complete and adjudicated to meet regulatory and compliance requirements, including timeliness
• Consult, or triage to, appropriate subject matter experts internally and across departments
• Work in a fast‑paced environment with strict compliance and turn‑around‑times for all work metrics (prior authorization requests, customer service inquiries, provider resolutions, etc.)

Remote Work

This position offers 100% remote work for candidates residing in Washington, Oregon, California.

• Washington
• Oregon
• California

Required Qualifications

• Bachelor’s Degree in Health related field, or applicable 2 years work experience may be substituted for some education
• 2 years experience in healthcare related field (or equivalent education)
• 1 year experience and proven track record of researching and resolving complex problems requiring critical thinking
• 2 years experience in fast‑paced working environment with a proven record of successful ability to quickly prioritize and resolve issues to meet timeliness and quality metrics
• 1 year experience in database management and spreadsheets
• 6 months experience with telephony systems, call center phone volumes and multi‑line communication systems

Preferred Qualifications

• 3 years experience in healthcare related field (or equivalent education)

Salary Range by Location

• California: Humboldt – Min: $29.62, Max: $45.31
• California: All Northern California – Except Humboldt – Min: $33.23, Max: $50.84
• California: All Southern California – Except Bakersfield – Min: $29.62, Max: $45.31
• California: Bakersfield – Min: $28.41, Max: $43.47
• Oregon: Non‑Portland Service Area – Min: $26.49, Max: $40.52
• Oregon: Portland Service Area – Min: $28.41, Max: $43.47
• Washington: Western – Except Tukwila – Min: $29.62, Max: $45.31
• Washington: Southwest – Olympia, Centralia & Below – Min: $28.41, Max: $43.47
• Washington: Tukwila – Min: $29.62, Max: $45.31
• Washington: Eastern – Min: $25.28, Max: $38.68
• Washington: South Eastern – Min: $26.49, Max: $40.52

Benefits

Our best‑in‑class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time‑off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time‑off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well‑being resources and much more. Learn more at providence.jobs/benefits.

About Providence

At Providence, our strength lies in Our Promise of ‘Know me, care for me, ease my way.’ Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best‑in‑class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100‑year tradition of serving the poor and vulnerable.

Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate’s placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on‑call, overtime, premiums, extra shift incentives, or bonus opportunities.

About The Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

Equal Opportunity

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Other Information

Requisition ID: 424798

Company: Providence Jobs

Job Category: Health Information Management

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Multiple shifts available

Career Track: Business Professional

Department: 5018 HCS MEDICAL MANAGEMENT OR REGION

Address: OR Portland 4400 NE Halsey St

Work Location: Providence Health Plaza (HR) Bldg 1-Portland

Workplace Type: Remote

Pay Range: $28.41 – $43.47