Top 13 Prior authorization specialist Jobs in San Marcos, Ca

Care Specialist - Inpatient - Sharp Rees-Stealy - Per Diem - Day Shift
Sharp HealthCare —San Diego, CA
- $30.98 - $43.37 an hour
- 8 hour shift
- Hospital
- Inpatient
- English
Prior Authorization Guidelines Specialist I (CPhT)
MedImpact Healthcare Systems —San Diego, CA
- $22.99 - $37.71 an hour
- Overtime
- Microsoft Word
- Computer literacy
- Basic math
- Paid holidays
- Disability insurance
IR Clinic Call Center Specialist - Per Diem
UC San Diego Health —San Diego, CA
- $34.64 - $36.73 an hour
- 8 hour shift
- Spanish
- Pass drug screening
- English
Call Center Specialist - LJ Pain Treatment Center
UC San Diego Health —San Diego, CA
- $29.15 - $36.24 an hour
- 8 hour shift
- Writing skills
- Pass drug screening
- Mid-level
Front Desk/Call Center Specialist - Float Team
UC San Diego Health —San Diego, CA
- $29.15 - $36.24 an hour
- 8 hour shift
- Writing skills
- Pass drug screening
- Mid-level
14d
Referral Specialist
Gary and Mary West PACE —San Marcos, CA
- From $23 an hour
- Full-time
- Microsoft Word
- Background check
- Microsoft Excel
- 403(b) matching
- Mileage reimbursement
Quick Apply
3d
Referral Coordinator
Vista Community Clinic —Vista, CA
- $21 - $23 an hour
- Spanish
- English
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
On-Site ROI Medical Records Specialist - Escondido, CA
Sharecare —Escondido, CA
- Up to $21 an hour
- Full-time
- Microsoft Excel
- Hospital
- HIPAA
Medical Records Technician (Release of Information)
US Veterans Health Administration —San Diego, CA
- $51,871 - $67,432 a year
- Online Application
- Hybrid work
- Background check
- High school
- Pass drug screening
- Health insurance
4h
Customer Care Specialist
Super Care, LLC —San Diego, CA
- $17.00 - $28.35 an hour
- Full-time
- Spanish
- Microsoft Outlook
- Computer literacy
- Paid training
- Health insurance
Quick Apply
14d
Pharmacy Technician II - Oncology Infusion - Varied - Torrey Pines
Scripps Health —La Jolla, CA
- $28.88 - $39.71 an hour
- Full-time
- Inventory management
- Mid-level
- High school diploma or GED
4d

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Front Desk Medical Assistant
Coastal Skin & Eye Institute —Encinitas, CA
Data entry, insurance verification, prior authorization requests. Create a pleasant and welcoming atmosphere for patients. This is a full time position.
$21.00 - $23.50 an hour
Quick Apply
Patient Service Rep-Radiology
Arch Health Partners, Inc. d/b/a Palomar Health Medical Group —Escondido, CA
Answers heavy volume of calls internally and incoming calls from referring providers; resolves call queries promptly.
$23.44 - $32.82 an hour
Quick Apply
5d

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Equitas Health, Inc. —Columbus, OH
Reliable transportation, driver’s license and proof of auto insurance required. Essential job functions include, but are not limited to, driving or having…
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Mount Carmel —Columbus, OH
Working knowledge of medical terminology, and data entry skills. Contacts physicians/office staff for clarification, if cases require clarification of diagnosis…

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Care Specialist - Inpatient - Sharp Rees-Stealy - Per Diem - Day Shift

Sharp HealthCare -
San Diego, CA

Apply Now

Job Details

Full-time | Per diem
$30.98 - $43.37 an hour

Qualifications

Managed care
Managed care organization experience
Quality data entry

Full Job Description

Job ID JR204949 Date posted 05/22/2026

San Diego, California

Sharp Memorial Hospital
Day
Per Diem

Responsibilities

Hours:

Shift Start Time:

Variable

Shift End Time:

Variable

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

Every Other

On-Call Required:

Hourly Pay Range (Minimum - Midpoint - Maximum):

$30.980 - $38.730 - $43.370

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do
To coordinates the completion of referrals for medical care and complex requests, including requests for outpatient care, elective inpatient admission, skilled nursing facility (SNF) admission, medical equipment (DME), home health, and transportation and prescription authorization in accordance with Sharp Rees-Stealy Medical Group (SRS) referral guidelines. To provide support and facilitation of care coordination services provided by the Case Managers to members.

Required Qualifications

Other : successful completion of ICD and CPT coding classes, or equivalent work experience.
3 Years working in the managed health care field, preferably HMO or delegated risk medical group/IPA setting.
1 Year experience with medical coding and data entry, preferably in a managed care environment.

Preferred Qualifications

Other : successful completion of Medical Assistant Program or equivalent.

Essential Functions

Assess the need for health care resources and insurance
Obtain detailed benefit coverage for specified plan member.
Check eligibility status.
Investigate and follow-up on all eligibility issues in accordance with health plan and SRS guidelines.
Department support
Maintain and organize data, prepare and distribute reports within designated timeframe.
Manage correspondence to members and PCP, health plans and other service providers.
Make phone calls to members, physician offices, health plans, and providers to assist in care coordination under the guidance of case managers.
Organize and maintain case files.
Provide clerical support and assistance to the Case Management team.
Contributes to the continuous improvement initiatives of the Case Management team to deliver quality interventions timely.
Maintain data, run reports in an organized and timely manner.
Completion of daily EA census, spreadsheet tracking, email notifications, office supply monitoring, maintain data and run department reports in an organized and timely manner.
Organize and implement daily work plan for designated facility.
Industry skills and competency
Obtain detailed benefit coverage for the more complex requests for service specific to member plan coverage.
Apply the principles of the medical group guidelines and Health Plan benefit guidelines to approve referrals designated at the Care Specialist level.
Investigate and follow-up on all eligibility issues in accordance with health plan and medical group guidelines.
Classify patients into full risk/shared risk grouping according to the Division of Financial Risk.
Identification of "Third Party Liability" (TPL) cases, completion of TPL form and forwarding of information to appropriate department/patients.
Process referrals for prior authorization
Responsible for submission of electronic Prior Auth referrals from generation, approval (at CS level) and acquisition.
Obtains necessary medical information for use by themselves, Medical Directors, the Hospitalist Physician and/or Case Manager.
Identifies and refer requests for review by higher level staff (Medical Director, Hospitalist or CM) within department turn-around time (TAT) standards.
Researches and assists in the denial process - gathers documentation after review by medical director, ensure that all information is complete, assesses and selects the appropriate denial reason. Maintain mandated TAT for denials.
Research and assist in the appeal process; gather documentation, ensure packet is complete and sent within appeal period.
Gathers clinical information from multiple sources including use of Sharp and/or Hospital applications to retrieve patient medical records for review by Case Managers.
Verifies and documents eligibility and benefit details.
Applies specific health plan criteria and/or guidelines to all prior authorization requests.
Professional development
Actively identifies gaps in skills and competencies and participates in seminars/classes to enhance gaps.
Attends and actively participates in department/team process/quality improvement activities.
Attends required training as scheduled by leadership team.

Knowledge, Skills, and Abilities

Proficient in medical terminology and current standards of clinical practice.
Proficient in use of ICD (current version), CPT and HCPC coding systems.
Proficient in typing and computer data entry.
Excellent organizational and time management skills including the ability to multitask. Excellent analytical and problem solving skills.
Excellent verbal and written communication skills.
Ability to read, speak and hear English clearly.
Ability to work independently in research and decision making with minimal direction from higher-level staff.
Travel between Sharp HealthCare facilities and corporate office is required; must have own transportation with adequate insurance or the ability to travel between facilities.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Other; Other

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Refine Your Search

prior authorization specialist jobs in san marcos, ca

Care Specialist - Inpatient - Sharp Rees-Stealy - Per Diem - Day Shift

Prior Authorization Guidelines Specialist I (CPhT)

IR Clinic Call Center Specialist - Per Diem

Call Center Specialist - LJ Pain Treatment Center

Front Desk/Call Center Specialist - Float Team

Referral Specialist

Referral Coordinator

On-Site ROI Medical Records Specialist - Escondido, CA

Medical Records Technician (Release of Information)

Customer Care Specialist

Pharmacy Technician II - Oncology Infusion - Varied - Torrey Pines

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