Job Title: Medicare Prior Authorization Consultant
 

Job Overview:
We are seeking a knowledgeable and strategic Medicare Prior Authorization Consultant to support our client’s healthcare operations. This 100% remote, contract-to-hire position focuses on enhancing and overseeing Medicare Advantage prior authorization programs, ensuring compliance with CMS regulations, and optimizing approval workflows. Candidates must reside outside of California, Alaska, and Hawaii due to contract restrictions.
 

Compensation:

• $75 – $125/hour

Work Schedule:

• Monday through Friday, standard business hours

Key Responsibilities of the Medicare Prior Authorization Consultant:

• Provide expert-level consultation on Medicare Advantage prior authorization operations
• Guide the development and implementation of scalable prior authorization programs
• Ensure alignment with CMS regulations (including 42 CFR Part 422) and Medicare policies
• Analyze and improve provider communication, appeals processes, and resubmission protocols
• Support compliance with NCDs, LCDs, HIPAA, and fraud/waste/abuse prevention requirements
• Collaborate with internal teams and external partners to maintain regulatory compliance
• Monitor and advise on authorization approval rates, processing times, and audit readiness

Qualifications and Skills for the Medicare Prior Authorization Consultant:

• 7+ years of Medicare Advantage prior authorization experience
• In-depth knowledge of CMS policies and Medicare Administrative Contractor (MAC) operations
• Experience managing high-volume prior authorization programs (10,000+ annually)
• Familiarity with clinical criteria review, medical necessity evaluation, and appeal workflows
• Strong grasp of healthcare compliance frameworks and data privacy requirements
• Prior work with MA plans or Medicare contractors preferred
• Advanced degree (MHA, MPH, MBA) or healthcare certifications (CHC, CHPC) a plus
• Clinical background (MD, RN, PharmD) desirable but not required

Why Join Us?
This is an opportunity to make a strategic impact within a rapidly evolving healthcare environment. You'll work alongside a passionate team focused on innovation and compliance while contributing to the improvement of care delivery and authorization efficiency across the Medicare landscape.
 

About Us:
Contemporary Staffing Solutions (CSS) is a trusted leader in providing contract, temporary, temp-to-hire, and direct hire staffing solutions. With decades of experience, we’ve grown from a staffing agency to a nationwide provider of workforce management solutions. Our niche recruitment expertise spans Accounting & Finance, Call Center & Office Support, Human Resources, Sales & Marketing, and Information Technology.
Explore more about CSS and how we connect great talent with exceptional opportunities by visiting www.ContemporaryStaffing.com.

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