Remote Prior Authorization Specialist Utilization Management

Randstad USA; Chicago (IL); Remote; USD 55,000 - 75,000; Full time

Job summary

Randstad USA is seeking an experienced Prior Authorization Specialist to join our national Utilization Management team. 100% remote role with a Monday–Friday schedule, 8:00 AM – 5:00 PM CST.

You will manage authorization queues, verify eligibility, gather medical documentation, and route requests to clinical reviewers to support timely access to care. The position requires 2+ years of prior authorization experience in healthcare, knowledge of medical terminology and insurance concepts, and

Qualifications

• Minimum of 2+ years of prior authorization experience in healthcare
• Experience with electronic authorization systems and data entry tools
• Strong knowledge of medical terminology and insurance concepts
• Excellent written and verbal communication and attention to detail

Responsibilities

• Actively monitor, review, and process incoming prior authorization requests and referrals from the assigned queue within required contractual timelines
• Process member approvals accurately to match members with qualified providers and ensure seamless access to healthcare services
• Verify member insurance coverage, benefit eligibility, and authorization guidelines using digital system tools to support timely claim adjudication and payment
• Research and compile key medical documentation to support clinical reviewers during determination
• Accurately enter and update authorization records in the utilization management system
• Identify services on the prior authorization list and route complex cases to clinical review staff
• Stay current on healthcare guidelines, authorization workflows, and compliance policies

Skills

Medical terminology

Insurance concepts

Authorization guidelines

Electronic authorization systems

Queue management

Data entry

Written communication

Verbal communication

Attention to detail

Organizational skills

Education

High School Diploma or GED

Tools

Electronic authorization systems

Queue management platforms

Data entry tools

Job description

Randstad USA is seeking an experienced Prior Authorization Specialist to join our national Utilization Management team. 100% remote role with a Monday–Friday schedule, 8:00 AM – 5:00 PM CST.

You will manage authorization queues, verify eligibility, gather medical documentation, and route requests to clinical reviewers to support timely access to care. The position requires 2+ years of prior authorization experience in healthcare, knowledge of medical terminology and insurance concepts, and