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Prior Authorization Nurse Jobs (NOW HIRING)

WomanCare Centers

Prior Authorization Nurse

Norfolk, VA · On-site

$25 - $31/hr

WomanCare Centers Prior Authorization Nurse We are a busy, patient-centered OB/GYN outpatient practice dedicated to providing compassionate, comprehensive care to women at every stage of life. Our ...

Urology Centers of Alabama

Prior Authorization

Homewood, AL · On-site

$18 - $24/hr

General Summary The Prior Authorization Specialist coordinates and secures insurance authorization for medications, in-office injections, and imaging when needed to support timely patient care. This ...

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How much do prior authorization nurse jobs pay per hour?

As of Aug 27, 2026, the average hourly pay for prior authorization nurse in the United States is $38.62, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $43.27 per hour, depending on experience, location, and employer.

What is a prior authorization nurse?

Prior Authorization Nurses are registered nurses who evaluate medical requests and determine if procedures, medications, or services meet clinical guidelines for insurance coverage. They work closely with healthcare providers, insurance companies, and patients to ensure that prior authorization requirements are met before treatments or medications are approved. Their role helps streamline care delivery, reduce unnecessary costs, and ensure patients receive appropriate, covered services in a timely manner.

What does a prior authorization nurse do?

As a prior authorization nurse, you review requests for authorization for specific medications, treatments, or surgeries. Your duties include reviewing medical records and documents related to the application. You consider each prior authorization request and collect evidence and patient information to support your decision. You communicate with the insurance provider to obtain additional information if needed. Your responsibilities in this position also involve ensuring the authorization meets regulations and requirements and contractual obligations of all parties involved. Your job can also require coordinating with administrators and healthcare providers to gain necessary information and ensure that patients receive authorized care.

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

To thrive as a Prior Authorization Nurse, you need a solid background in nursing, knowledge of insurance guidelines, and an active RN license. Familiarity with prior authorization software, electronic health records (EHRs), and payer-specific portals is typically required. Strong attention to detail, critical thinking, and effective communication help in collaborating with providers and navigating complex cases. These skills are essential to ensure accurate, timely authorization of medical services, which directly impacts patient care and healthcare reimbursement.

What are some common challenges faced by prior authorization nurses in coordinating with insurance providers?

Prior Authorization Nurses often encounter challenges such as navigating varying requirements from different insurance providers, managing tight turnaround times for approvals, and ensuring that clinical documentation is thorough and accurate. Effective communication and attention to detail are essential, as missing or unclear information can delay authorizations. Building collaborative relationships with providers, physicians, and insurance representatives helps streamline the process and improves patient outcomes.

What is the difference between Prior Authorization Nurse vs Utilization Review Nurse?

AspectPrior Authorization NurseUtilization Review Nurse
CredentialsRN license, possibly certifications in case managementRN license, certifications in case management or utilization review
Work EnvironmentHealthcare facilities, insurance companies, or telehealthHospitals, insurance companies, or managed care organizations
Job FocusPre-authorization of specific procedures or treatmentsReviewing medical necessity and appropriateness of ongoing care

While both roles involve nursing expertise and work within healthcare and insurance settings, the Prior Authorization Nurse primarily focuses on obtaining approval before procedures, whereas the Utilization Review Nurse evaluates ongoing care for medical necessity. Understanding these differences helps in choosing the right career path or job search focus.

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Prior Authorization Nurse jobs near you
Infographic showing various Prior Authorization Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Prior Authorization Nurse

WomanCare Center, PLC

Norfolk, VA • On-site

Other

PTO

Posted 8 days ago

Job description

WomanCare Centers Prior Authorization Nurse

We are a busy, patient-centered OB/GYN outpatient practice dedicated to providing compassionate, comprehensive care to women at every stage of life. Our team values communication, collaboration, and continuity of care—both in and out of the office. We're seeking an experienced Medication Prior Authorization Nurse to join our dynamic team in an in-person, non-remote position. The primary focus of this role is the timely and accurate management of medication prior authorizations, working closely with providers, pharmacies, insurance companies, and patients to facilitate access to prescribed medications.

Responsibilities:
  • Manage medication prior authorizations as the primary responsibility of the position, including initiating, completing, submitting, and tracking prior authorization requests.
  • Review medication orders and insurance requirements to determine appropriate prior authorization processes and required documentation.
  • Gather and submit supporting clinical documentation, including diagnoses, treatment history, laboratory results, and other information required for authorization.
  • Monitor pending prior authorizations and proactively follow up to ensure timely resolution and minimize delays in patient treatment.
  • Assist with appeals, reconsiderations, peer-to-peer requests, and alternative medication options when prior authorization requests are denied, as directed by the provider.
  • Maintain accurate and timely documentation of all prior authorization activities in the electronic health record (EHR).
  • Process medication refill requests as appropriate, ensuring clinical appropriateness and adherence to established protocols.
  • Stay current with payer requirements, medication authorization processes, and changes that may affect patient access to medications.
  • Other duties as assigned.
Qualifications Desired
  • Minimum of 2 years of nursing experience in Prior Authorizations.
  • Strong clinical assessment, critical thinking, and problem-solving skills.
  • Excellent communication, organization, documentation, and time-management skills.
  • Strong attention to detail and ability to manage multiple prior authorizations and follow-up tasks simultaneously.
  • Ability to work independently while collaborating effectively with providers, pharmacies, insurance companies, and members of the care team.
  • Compassionate, patient-centered approach to care.
  • Ability to work in person; this position is not eligible for remote work.
  • Familiarity with medication formularies.
  • Knowledge of common OB/GYN conditions, including prenatal care, contraception, menstrual issues, menopause, infections, and pregnancy complications.
Why Join Our Team?
  • Paid time off that increases with tenure.
  • Major federally recognized holidays off with pay.
  • Competitive benefits package with optional supplemental benefits.
  • Leadership dedicated to cultivating and maintaining a positive environment that encourages professional growth.
  • Opportunities to take on healthy challenges and develop your clinical and administrative skills.
  • A collaborative team environment with coworkers who encourage and support one another in achieving success.

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