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Full Time Prior Authorization Rn Jobs (NOW HIRING)

CareMed Specialty Pharmacy

$23 - $25/hr

Pharmacy Prior Authorization Specialist - CareMed Specialty Pharmacy Buffalo, NY | Full-Time | Starting at $23.00/hr and up Sign-On Bonus: $5,000 for employees starting before July 31, 2026. Join a ...

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Curant Health

Prior Authorization Specialist

Smyrna, GA

$17.50 - $23.50/hr

The Prior Authorization specialist responsibilities includes: taking in-bound calls from providers ... Registered Pharmacy Technician Why Work for Us? We offer competitive pay, paid holidays, benefits ...

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How much do full time prior authorization rn jobs pay per hour?

As of May 30, 2026, the average hourly pay for full time prior authorization rn in the United States is $42.24, according to ZipRecruiter salary data. Most workers in this role earn between $31.49 and $50.00 per hour, depending on experience, location, and employer.

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 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 Full Time Prior Authorization RNs?

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 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 are hiring for Full Time Prior Authorization Rn jobs? Cities with the most Full Time 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:
What states have the most Full Time Prior Authorization Rn jobs? States with the most job openings for Full Time Prior Authorization Rn jobs include:
Full Time Prior Authorization Rn jobs near you

Registered Nurse (RN) - Prior Authorization & Program Exception Review (Hybrid)

The CKHobbie Group

Harrisburg, PA • Hybrid

$34 - $35/hr

Full-time

Posted 14 days ago

Job description

We are seeking a Registered Nurse (RN) – Medical Necessity Review (Prior Authorization / Program Exception) to support the Pennsylvania Medical Assistance (Medicaid) program in a full-time, long-term contract role based in Harrisburg, PA, with a hybrid schedule (three days remote, two days onsite). This position focuses on reviewing outpatient authorization requests and program exception cases to ensure services are medically necessary, appropriately delivered, and compliant with state and federal regulations.

In this role, the nurse will review outpatient service authorization requests, including Prior Authorization and 1150 Waiver (Program Exception) requests for services such as medical supplies, prosthetics, orthotics, durable medical equipment (DME), skilled nursing care, home health services, and emergency medical services. The RN will evaluate clinical documentation to determine whether requested items and services meet Medical Assistance requirements for necessity.

The position also involves assessing requests that exceed standard fee schedules or quantity limits and coordinating with Rate Setting when additional pricing review is required. The nurse will ensure that appropriate fees are applied and that all determinations align with program guidelines while meeting established productivity standards.

This role requires strong analytical skills, attention to detail, and the ability to interpret medical records and regulatory requirements. The RN will work both independently and collaboratively to ensure accurate determinations, support program integrity, and maintain compliance across all authorization and exception review processes.