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Full Time Prior Authorization Rn Jobs in Massachusetts

Valley Health Systems

Registered Nurse

Holyoke, MA

$34.33 - $53.81/hr

$5,000 SIGN-ON BONUS FOR FULL-TIME RN WITH AT LEAST TWO YEARS OF EXPERIENCE AS AN RN Note: The ... * Assist in prior authorizations, prescription refills, and adherence to clinical protocols.

Valley Health Systems

Registered Nurse

Holyoke, MA

$34.33 - $53.81/hr

$5,000 SIGN-ON BONUS FOR FULL-TIME RN WITH AT LEAST TWO YEARS OF EXPERIENCE AS AN RN Note: The ... prior authorizations, prescription refills, and adherence to clinical protocols Qualifications:

Valley Health Systems

Registered Nurse

Holyoke, MA · On-site

$34.33 - $53.81/hr

$5,000 SIGN-ON BONUS FOR FULL-TIME RN WITH AT LEAST TWO YEARS OF EXPERIENCE AS AN RN Note: The ... * Assist in prior authorizations, prescription refills, and adherence to clinical protocols.

Valley Health Systems

Registered Nurse

Holyoke, MA · On-site

$34.33 - $53.81/hr

$5,000 SIGN-ON BONUS FOR FULL-TIME RN WITH AT LEAST TWO YEARS OF EXPERIENCE AS AN RN Note: The ... prior authorizations, prescription refills, and adherence to clinical protocols Qualifications:

Fenway Health

LPN

Boston, MA · On-site

$28.21 - $31.13/hr

Job Type Full-time Description Our nurses are the heart and soul of Fenway Health. Every day, they ... Works with MA and pharmacy to call in prescription refills or obtain prior authorizations * Assists ...

Vinfen

Clinical Care Manager (RN)

Hyannis, MA · On-site

$90K/yr

The RN is supervised by the Care Team Leader and will learn about working on a community-based ... Obtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary ...

Vinfen

Clinical Care Manager (RN)

Allston, MA · On-site

$90K/yr

The RN is supervised by the Care Team Leader and will learn about working on a community-based ... Obtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary ...

FENWAY HEALTH

LPN

Boston, MA

$28.21 - $31.13/hr

Provides nursing support to RNs, LPNs and MAs * Places and Maintains IV Lines * Administers ... Works with MA and pharmacy to call in prescription refills or obtain prior authorizations * Assists ...

Fenway Health

LPN

Boston, MA · On-site

$28.21 - $31.13/hr

Provides nursing support to RNs, LPNs and MAs * Places and Maintains IV Lines * Administers ... Works with MA and pharmacy to call in prescription refills or obtain prior authorizations * Assists ...

Vinfen

Clinical Care Manager (RN)

Somerville, MA · On-site

$90K/yr

The RN is supervised by the Care Team Leader and will learn about working on a community-based ... Obtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary ...

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All JobsPrior Authorization Rn JobsFull Time Prior Authorization Rn JobsFull Time Prior Authorization Rn Jobs in Massachusetts

Full Time Prior Authorization Rn information

What is a full time prior authorization RN?

Full Time Prior Authorization Registered Nurses (RNs) are healthcare professionals who work primarily in administrative roles to review and evaluate medical service requests. Their main responsibility is to determine if specific treatments, medications, or procedures meet insurance company criteria for coverage before they are provided to patients. They use their clinical knowledge to assess medical necessity and ensure compliance with healthcare policies and guidelines. These nurses typically interact with physicians, insurance companies, and patients to manage authorizations and appeals, ensuring that care is both appropriate and covered under a patient’s health plan.

What are some typical challenges faced by full time prior authorization RNs, and how can they be managed?

Full Time Prior Authorization RNs often encounter challenges related to navigating complex insurance guidelines, managing high caseloads, and ensuring timely communication between healthcare providers and payers. Staying organized, keeping up-to-date with frequently changing insurance policies, and developing strong collaboration skills with both clinical and administrative teams are key to success in this role. Leveraging electronic health records and standardized workflows can also help streamline the authorization process and reduce delays for patients.

What are the key skills and qualifications needed to thrive as a full time prior authorization RN, and why are they important?

To thrive as a Full Time Prior Authorization RN, you need a strong nursing background (active RN license), in-depth knowledge of medical terminology, and experience with insurance processes or utilization review. Familiarity with prior authorization software, electronic health records (EHRs), and insurance payer portals is typically required. Exceptional attention to detail, critical thinking, and strong communication skills help you effectively evaluate medical necessity and advocate for patient care. These abilities ensure timely, accurate authorizations, reduce claim denials, and promote optimal patient outcomes.

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

AspectFull Time Prior Authorization RnMedical Coder
CredentialsRN license, certification in case management or utilization reviewCertification in coding (CPC, CCS), knowledge of medical coding systems
Work EnvironmentHealthcare facilities, insurance companies, utilization review departmentsMedical offices, hospitals, insurance companies, coding agencies
Job FocusReviewing and authorizing medical procedures and treatmentsTranslating medical records into standardized codes for billing

While both roles require healthcare knowledge, the Full Time Prior Authorization RN focuses on evaluating medical necessity for treatments, whereas Medical Coders translate medical documentation into codes for billing. Both are essential in healthcare administration but serve different functions within the patient care and billing process.

What cities in Massachusetts are hiring for Full Time Prior Authorization Rn jobs?

Cities in Massachusetts with the most Full Time Prior Authorization Rn job openings:

Full Time Prior Authorization Rn jobs near you

Registered Nurse

Valley Health Systems

Holyoke, MA

$34.33 - $53.81/hr

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 24 days ago

Job description

$5,000 SIGN-ON BONUS FOR FULL-TIME RN

WITH AT LEAST TWO YEARS OF EXPERIENCE AS AN RN


Note: The compensation range noted above represents the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range.
Valley Health Systems, Inc., the parent company of Holyoke Medical Center, provides a broad range of physician services in offices conveniently located throughout Western Massachusetts. Holyoke Medical Center is an independent community hospital that has served the healthcare needs of the Pioneer Valley for over 125 years. We continue to grow and address the needs of our community through quality and patient-centered care.
Our Gastroenterology Practice is seeking an experienced Registered Nurse to deliver patient-centered nursing care and support the coordination of services across the care continuum, ensuring safe, efficient, and high-quality clinical outcomes.
The Office Nurse serves as a critical link between patients, MDs / Providers, and the care team across the continuum of surgical care. This role combines clinical expertise with care coordination, ensuring timely access, seamless navigation, and high-quality patient-centered care from initial consultation through post-operative follow-up. 

Key responsibilities include but are not limited to:

  • Perform comprehensive nursing assessments
  • Administer medications, injections, and care in accordance with clinical protocols
  • Provide direct clinical support during office visits, minor procedures, and follow-up care
  • Review diagnostic results (labs, imaging) and escalate findings appropriately to MDs/Providers.
  • Serve as the primary point of contact for patients throughout the patient's journey.
  • Coordinate pre-operative requirements, including medical clearances, labs, imaging, and consultations
  • Facilitate timely scheduling of procedures and patient navigation in collaboration with the manager, surgical schedulers and nurses.
  • Educate patients and families on procedures, risks, preparation, and recovery expectations
  • Conduct follow-ups, including symptom management, assessment, and complication screening
  • Triage calls and coordinate escalation when clinically indicated.
  • Deliver clear, compassionate, and culturally competent education aligned with AIDET principles
  • Collaborate with the Manager, front desk, surgery schedulers, and MDs and Providers to optimize patient flow and access.
  • Support referral management and ensure appropriate clinical prioritization
  • Assist in reducing booking delays, cancellations, and no-shows through proactive coordination with the Manager and Surgery Schedulers.
  • Maintain accurate, timely documentation within the EMR (e.g., Meditech Expanse)
  • Complete FMLA/Disability Paperwork
  • Ensure compliance with DNV's standards, regulatory, infection control, and safety standards
  • Assist in prior authorizations, prescription refills, and adherence to clinical protocols.


Qualifications:
Education: Graduate of an accredited program for Registered Nurses
License/Certification: Current license as a Registered Nurse within the Commonwealth of Massachusetts; current CPR
Experience: Two years of experience in an outpatient physician's office, preferably in a specialty.
Our competitive salary package is adjusted to align with a candidate's relevant experience and skills. We also offer:

  • Low cost health insurance with no deductibles when using HMC services
  • Dental and vision insurance
  • Free disability and life insurance
  • 403(b) plan
  • Up to $8000 in degree/tuition reimbursement
  • In-House Pharmacy
  • Relaxation Room and Fitness Center
  • Other voluntary benefits, such as LegalShield, Pet Insurance
  • Free onsite parking

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