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

BCforward

Prior Authorization

Raleigh, NC · On-site

$17.50 - $23.25/hr

Company Description About BCforward BCforward began as an IT business solutions and staffing firm. Founded in 1998, BCforward has grown with our customers' needs into a full service personnel ...

Summit BHC

Intake Clinician- Full Time

Raleigh, NC · On-site

$36K - $41K/yr

Facilitates intake, admission, and prior authorization process for incoming patients. * Performs ... In some states, may also be a registered nurse, in which case, an associate's or bachelor's degree ...

Actalent

Pharmacy Technician

Cary, NC

$17.25 - $21/hr

Utilize knowledge of prior authorization workflows to assist with medication access and insurance-related issues. * Escalate clinical questions and concerns to pharmacists, nurses, or other ...

Duke Health

RN Care Coordinator-Pediatrics

Durham, NC · On-site

We are seeking an RN Care Coordinator in our Duke Children's Specialty Creekstone clinic located in ... prior authorization forms. * Completes clinical paperwork including lab, school, and leave forms ...

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All JobsPrior Authorization Nurse JobsPrior Authorization Nurse Jobs in Raleigh, NC

Prior Authorization Nurse information

See Raleigh, NC salary details

$16

$37

$63

How much do prior authorization nurse jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for prior authorization nurse in Raleigh, NC is $37.46, according to ZipRecruiter salary data. Most workers in this role earn between $28.70 and $41.97 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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Cities near Raleigh, NC with the most Prior Authorization Nurse job openings:

Prior Authorization Nurse jobs near you
Infographic showing various Prior Authorization Nurse job openings in Raleigh, NC as of August 2026, with employment types broken down into 67% Full Time, 20% Part Time, and 13% Contract. Highlights an 93% In-person, and 7% Remote job distribution, with an average salary of $70,917 per year, or $34.1 per hour.

Prior Authorization

BCforward

Raleigh, NC • On-site

$17.50 - $23.25/hr

Full-time

Re-posted 29 days ago

Job description

Company Description

About BCforward BCforward began as an IT business solutions and staffing firm. Founded in 1998, BCforward has grown with our customers' needs into a full service personnel solutions organization. BCforward's headquarters are in Indianapolis, Indiana and also operates delivery centers in 17 locations in North America as well as Hyderabad, India and Puerto Rico. We are currently the largest consulting firm and largest MBE certified firm headquartered in Indiana. With 14+ years of uninterrupted growth, the addition of two brands (Stafforward and PMforward) and a team of more than 1400 resources our teams deliver services for multiple industries from both public and private sectors. BCforward's team of dedicated staffing professionals has placed thousands of talented people over the past decade, with retention rates that are consistently higher than the industry average.

Job Description

Provide functional and/or technical expertise to plan, analyze, define and support the delivery of future functional and technical capabilities for an application or group of applications. Assist in facilitating impact assessment efforts and in producing and reviewing estimates for client work requests. 

Hours: 8:00am to 5:00pm

Additional Information

Must be able to pass a background and drug screen

BCforward logo

About BCforward

Sourced by ZipRecruiter

BCforward began as an IT business solutions and staffing firm. Founded in 1998, BCforward has grown with our customers' needs into a full service personnel solutions organization. Headquartered in Indianapolis, Indiana, BCforward also operates numerous delivery centers across North America and India. We are currently the largest consulting firm and largest MBE certified firm in Indiana. Our uninterrupted growth has allowed BCforward to deliver uniquely configured IT staffing and project solutions for over years of catering to our customers' specific needs. BCforward currently maintains a team of over 5000 global resources. With our additional brand, Stafforward, together we have the capabilities to deliver services for a variety of industries in both public and private sectors which allows us to address your most challenging needs.

Industry

It services

Company size

5,001 - 10,000 Employees

Headquarters location

Indianapolis, IN, US

Year founded

1998

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