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Medical Prior Authorization Jobs in Raleigh, NC (NOW HIRING)

RALEIGH MEDICAL GROUP PA

Certified Medical Assistant

Cary, NC · On-site

$16.75 - $21.50/hr

Certified Medical Assistant (CMA)/Registered Medical Assistant (RMA) - GI Location: In-Office ... Facilitates prior authorizations, referrals, and managed care requirements as needed * Processes ...

McKesson Corporation

Reimbursement Case Manager

Cary, NC · On-site

$25 - $26/hr

Experience conducting benefit investigations and verifying medical and pharmacy benefits. * Prior authorization and appeal support experience. * Direct customer service, patient support, case ...

McKesson

Reimbursement Case Manager

Cary, NC · Hybrid

$25 - $26/hr

Experience conducting benefit investigations and verifying medical and pharmacy benefits. * Prior authorization and appeal support experience. * Direct customer service, patient support, case ...

McKesson

Reimbursement Case Manager

Cary, NC · Hybrid

$25 - $26/hr

Experience conducting benefit investigations and verifying medical and pharmacy benefits. * Prior authorization and appeal support experience. * Direct customer service, patient support, case ...

EmergeOrtho

Medical Assistant

Smithfield, NC · On-site

$15.25 - $19.75/hr

Obtains prior authorization for procedures, equipment, and medication, if appropriate * Schedules ... medical team includes upwards of 170 highly trained orthopedic specialists and nearly as many ...

EmergeOrtho

Medical Assistant

Smithfield, NC · On-site

$15.25 - $19.75/hr

Obtains prior authorization for procedures, equipment, and medication, if appropriate * Schedules ... medical team includes upwards of 170 highly trained orthopedic specialists and nearly as many ...

EmergeOrtho

Medical Assistant

Smithfield, NC · On-site

$15.25 - $19.75/hr

Obtains prior authorization for procedures, equipment, and medication, if appropriate * Schedules ... medical team includes upwards of 170 highly trained orthopedic specialists and nearly as many ...

EmergeOrtho

Medical Assistant

Raleigh, NC · On-site

$17.25 - $22/hr

Medical Assistant Opportunity in the Triangle Region! EmergeOrtho is committed to being the trusted ... Obtains prior authorization for procedures, equipment, and medication, if appropriate * Schedules ...

EmergeOrtho

Medical Assistant

Raleigh, NC · On-site

$17.25 - $22/hr

Medical Assistant Opportunity in the Triangle Region! EmergeOrtho is committed to being the trusted ... Obtains prior authorization for procedures, equipment, and medication, if appropriate * Schedules ...

ECAA Anesthesia Specialists

Medical Assistant

Raleigh, NC

$15.75 - $20/hr

Daily responsibilities include various administrative tasks such as conducting medication prior authorizations and documenting medical information into the electronic medical records (EMR) system.

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Medical Prior Authorization information

See Raleigh, NC salary details

$12

$22

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How much do medical prior authorization jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for medical prior authorization in Raleigh, NC is $22.31, according to ZipRecruiter salary data. Most workers in this role earn between $17.07 and $23.61 per hour, depending on experience, location, and employer.

What is medical prior authorization?

Medical prior authorization is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication before it is provided. Providers must submit a request for approval, including supporting documentation, to the insurance company. This process helps ensure that the service is medically necessary and meets the insurer's coverage criteria. Obtaining prior authorization does not guarantee payment, but it is often required to avoid claim denials and delays in patient care.

What are the key skills and qualifications needed to thrive as a medical prior authorization specialist?

To thrive as a Medical Prior Authorization Specialist, you need in-depth knowledge of insurance policies, medical terminology, and healthcare regulations, typically supported by experience in medical billing or healthcare administration. Proficiency in prior authorization software, electronic health record (EHR) systems, and understanding of payer portals is essential. Strong attention to detail, excellent communication, and organizational skills help you navigate complex approval processes and interact effectively with providers and insurers. These skills ensure timely and accurate authorization of medical services, reducing delays in patient care and minimizing claim denials.

What are some common challenges faced in a medical prior authorization role, and how are they typically addressed?

A common challenge in Medical Prior Authorization is managing high volumes of requests while ensuring timely and accurate approvals. Specialists often deal with complex insurance policies and must coordinate closely with healthcare providers and insurance companies to obtain necessary documentation. To address these challenges, most teams utilize specialized software and standardized workflows, and regular training is provided to stay updated on changing regulations. Strong communication and organizational skills are essential for navigating these complexities and ensuring patients receive prompt care.

What is the difference between Medical Prior Authorization vs Medical Claims Specialist?

AspectMedical Prior AuthorizationMedical Claims Specialist
Required credentialsOften requires healthcare or insurance-related certificationsTypically requires insurance or billing certifications
Work environmentHealthcare offices, insurance companies, or hospitalsInsurance companies, healthcare providers, or billing departments
Employer and industry usageUsed in healthcare and insurance to approve proceduresUsed in insurance to process and adjudicate claims
Common search and comparison intentUnderstanding approval process for treatmentsUnderstanding claims processing and reimbursement

Medical Prior Authorization involves obtaining approval from insurance before certain treatments or procedures, ensuring coverage. Medical Claims Specialists handle the processing and reimbursement of insurance claims after services are provided. While both roles work within healthcare insurance, prior authorization focuses on pre-approval, whereas claims specialists manage post-service billing and claims processing.

How do I become a medical prior authorization specialist?

To become a medical prior authorization specialist, candidates typically need a high school diploma or equivalent, along with knowledge of medical billing, insurance processes, and healthcare regulations. Relevant skills include attention to detail, communication, and familiarity with electronic health record (EHR) systems; certifications such as the Certified Medical Administrative Specialist (CMAS) can enhance job prospects.

What career paths follow medical prior authorization?

Medical prior authorization professionals often advance to roles such as healthcare compliance specialists, insurance claims analysts, or healthcare managers. They may also pursue certifications in healthcare administration or coding to expand their career opportunities within the healthcare and insurance industries.

What cities near Raleigh, NC are hiring for Medical Prior Authorization jobs?

Cities near Raleigh, NC with the most Medical Prior Authorization job openings:

Medical Prior Authorization jobs near you
Infographic showing various Medical Prior Authorization job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $46,400 per year, or $22.3 per hour.

Prior Authorization Clinical Pharmacist

Elevance Health

Durham, NC • On-site

$114K - $136K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 6 days ago

Elevance Health rating

7.5

Company rating: 7.5 out of 10

Based on 354 frontline employees who took The Breakroom Quiz

218th of 315 rated insurance

Job description

Anticipated End Date:

2026-09-03

Position Title:

Prior Authorization Clinical Pharmacist

Job Description:

Prior Authorization Clinical Pharmacist

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Prior Authorization Clinical Pharmacist is responsible for evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use. This role supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug Information Services (DIS), and formulary management.

How you will make an impact:

  • Researches and synthesizes detailed clinical data related to pharmaceuticals.

  • Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee.

  • May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinates with internal stakeholders or health plan medical directors as needed.

  • Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions.

  • Prepares information for network physicians.

  • Prepares and presents therapeutic class reviews and drug monographs to the Pharmacy and Therapeutics (P&T) Committee.

  • Provides clinical guidance for therapeutic interventions, dosage conversions, and evidence-based medication use.

  • Develops and communicates drug information and recommendations to network physicians and clinical teams.

Minimum Requirements:

  • Requires BA/BS in Pharmacy.

  • Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.

  • Requires a registered pharmacist.

  • Current unrestricted Pharmacist license in applicable state(s) required.

  • For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.

Preferred Skills, Capabilities and Experiences:

  • Active, unrestricted license to practice pharmacy as a Registered Pharmacist (RPh) in the state of Kansas highly preferred.

  • PharmD preferred.

  • PBM experience preferred.

  • Prior Authorization experience preferred.

  • Specialty Medication experience preferred.

Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, unless they are command-sanctioned activities.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

MED > Licensed/Registered Pharmacist/Pharmacy Technician

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.


Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.


How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.


The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.


Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.


Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.


NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

Social media

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