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Contractual Prior Authorization Rn Jobs (NOW HIRING)

Anchor Health CT

Prior Authorization Specialist

Hamden, CT · On-site

$48K - $62K/yr

Track, follow up, and document all authorization statuses to ensure timely patient access to care. * Assist providers and nurses with prior authorization questions, refill coordination, and pharmacy ...

W3R

RN Prior Authorization

Austin, TX

The Registered Nurse conducts pre-service, concurrent/ retrospective reviews. * They will collaborate with healthcare providers to promote quality member outcomes, to optimize member benefits, and to ...

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How much do contractual prior authorization rn jobs pay per hour?

As of May 31, 2026, the average hourly pay for contractual prior authorization rn in the United States is $36.49, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $38.46 per hour, depending on experience, location, and employer.

What is the difference between Contractual Prior Authorization Rn vs Medical Coder?

AspectContractual Prior Authorization RnMedical Coder
CredentialsRN license, certifications in prior authorizationCertification in coding (CPC, CCS)
Work EnvironmentHealthcare facilities, insurance companiesMedical offices, coding departments
Industry UsageInsurance, healthcare providersHealthcare administration, billing

Contractual Prior Authorization Rns and Medical Coders both work within healthcare but focus on different tasks. Rns handle authorization requests to approve treatments, while Medical Coders translate medical records into billing codes. Both roles require specialized certifications and are essential in healthcare administration, often working in similar environments but with distinct responsibilities.

What cities are hiring for Contractual Prior Authorization Rn jobs? Cities with the most Contractual Prior Authorization Rn job openings:
What are the most commonly searched types of Prior Authorization Rn jobs? The most popular types of Prior Authorization Rn jobs are:
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Contractual Prior Authorization Rn jobs near you

Prior Authorization Specialist

Serv Recruitment Agency

Albuquerque, NM

$17.50 - $23.25/hr

Full-time

Posted 2 days ago

Job description

Position Summary

The Prior Authorization Specialist is responsible for obtaining timely insurance authorizations for clinic-based services, including infusion therapies (such as chemotherapy and biologics), surgical procedures, and oral specialty medications. This role plays a critical part in ensuring patients receive medically necessary care without delays by coordinating authorization activities across providers, payers, pharmacy, and clinical staff in a fast-paced outpatient clinic environment.

Key Responsibilities

  • Obtain prior authorizations for clinic-based services, including:
    • Infusion therapies (chemotherapy, immunotherapy, biologics, and supportive medications)
    • Surgical procedures and related services
    • Oral and specialty medications
  • Review provider orders, clinical notes, operative plans, and supporting documentation to ensure completeness and payer compliance
  • Submit authorization requests via payer portals, electronic systems, phone, and fax
  • Verify insurance benefits, coverage criteria, and payer-specific requirements, including step therapy, site-of-care rules, and clinical guidelines
  • Track authorization status and proactively follow up with insurance carriers to secure timely determinations
  • Communicate authorization approvals, denials, and pending requirements to providers, nurses, surgery schedulers, pharmacy, and front-desk teams
  • Coordinate peer-to-peer reviews and appeal processes with providers and leadership when authorizations are denied or delayed
  • Ensure authorizations are obtained prior to scheduled clinic visits, infusion appointments, surgeries, or medication dispensing
  • Maintain accurate and up-to-date documentation in the electronic medical record (EMR) and authorization tracking systems
  • Collaborate with billing and coding staff to ensure authorized services align with CPT, HCPCS, ICD-10 codes, and payer requirements
  • Stay current on payer policies, clinic workflows, and regulatory standards impacting outpatient services
  • Maintain compliance with HIPAA, organizational policies, and payer regulations

Required Qualifications

  • High school diploma or equivalent (Associate's degree preferred)
  • Minimum of 2 years of experience in prior authorization and healthcare revenue cycle.
  • Demonstrated experience with medication and procedural authorizations
  • Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans
  • Proficiency with EMR systems and insurance payer portals
  • Strong organizational skills with the ability to manage multiple authorization requests simultaneously
  • Excellent written and verbal communication skills

Preferred Qualifications

  • Prior experience in a clinic, outpatient specialty practice, or ambulatory surgery setting
  • Experience with oncology, infusion services, or surgical scheduling
  • Knowledge of oral oncolytics and specialty pharmacy coordination
  • Familiarity with CPT, HCPCS, ICD-10 coding and medical necessity guidelines

Skills & Competencies

  • High attention to detail and accuracy
  • Strong follow-through and time management skills
  • Ability to work independently while supporting a multidisciplinary clinic team
  • Problem-solving skills with a patient-centered approach
  • Comfort working with time-sensitive and high-priority cases

Work Environment

  • Specialty practice setting
  • Primarily administrative role with frequent collaboration with clinical and scheduling staff
  • Fast-paced environment requiring prioritization of urgent authorizations for procedures, infusions, and medications
Employment Type: FULL_TIME

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