ZipRecruiter

Log In

1

Prior Authorization Nurse Jobs in Riverside, CA (NOW HIRING)

Oso Home Care

Authorization Specialist

Irvine, CA · On-site

$21 - $25.90/hr

... nursing staff, and internal departments to facilitate patient access to care. This position works ... Submit prior authorization requests to commercial insurance carriers, Medicare Advantage plans ...

Oso Home Care

Authorization Specialist

Irvine, CA · On-site

$21 - $25.90/hr

... nursing staff, and internal departments to facilitate patient access to care. This position works ... Submit prior authorization requests to commercial insurance carriers, Medicare Advantage plans ...

Inspire Healthcare

Medical Director Physician

Pomona, CA · Remote

$250K - $350K/yr

Review prior authorization requests and determine medical necessity using evidence-based clinical guidelines. * Approve, deny, modify, or redirect services as appropriate. * Collaborate with nurses ...

next page

Showing results 1-20

All JobsPrior Authorization Nurse JobsPrior Authorization Nurse Jobs in Riverside, CA

Prior Authorization Nurse information

See Riverside, CA salary details

$18

$40

$68

How much do prior authorization nurse jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for prior authorization nurse in Riverside, CA is $40.29, according to ZipRecruiter salary data. Most workers in this role earn between $30.87 and $45.14 per hour, depending on experience, location, and employer.

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.

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 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 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.
More about Prior Authorization Nurse jobs
What are popular job titles related to Prior Authorization Nurse jobs in Riverside, CA? For Prior Authorization Nurse jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Nurse jobs in Riverside, CA look for? The top searched job categories for Prior Authorization Nurse jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Prior Authorization Nurse jobs? Cities near Riverside, CA with the most Prior Authorization Nurse job openings:
Prior Authorization Nurse jobs near you
Infographic showing various Prior Authorization Nurse job openings in Riverside, CA as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $83,797 per year, or $40.3 per hour.

Prior Authorization LVN

LSMA Management Inc

San Bernardino, CA • On-site

$35 - $40/hr

Full-time

Posted 16 days ago

Job description

Description:

JOB SUMMARY:

The Prior Authorization Nurse (LVN) is responsible for performing clinical review and evaluation of authorization requests to ensure medical necessity, appropriate utilization of healthcare services, and compliance with regulatory and health plan requirements. This role conducts prospective, concurrent, and retrospective review of medical services including specialty care, diagnostic procedures, elective admissions, post-acute services, and out-of-network referrals. The Prior Authorization LVN collaborates with providers, health plans, and internal clinical teams to support timely care coordination while ensuring adherence to CMS, NCQA, and organizational guidelines. The position serves as a clinical resource to Prior Authorization Coordinators and supports efficient utilization management operations.

Requirements:

MINIMUM & PREFERRED QUALIFICATIONS:


Education/Training

Minimum: High School diploma or equivalent required. Graduate from an accredited Vocational Nursing Program.


Experience

Minimum: At least one year of clinical experience in a healthcare setting. Basic knowledge of medical terminology, utilization management processes, and clinical care practices.

Preferred: Two or more years of utilization management, prior authorization, case management, or managed care experience. Experience working in an MSO, IPA, health plan, or medical group environment. Experience using Milliman Care Guidelines (MCG), InterQual, or similar criteria tools. Knowledge of ICD-10, CPT, and HCPCS coding. Experience with electronic health record and utilization management systems.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.


Certification(s)

Current, active, unrestricted California LVN license required.

Skills, Knowledge & Abilities

· Knowledge of utilization management principles, medical necessity criteria, and managed care processes.

· Understanding of clinical documentation and healthcare delivery systems.

· Familiarity with regulatory requirements including NCQA, CMS, and HIPAA.

· Strong verbal and written communication skills.

· Ability to effectively communicate with physicians, providers, and interdisciplinary teams.

· Ability to provide clear and professional clinical guidance.

· Ability to review and interpret clinical information and apply established criteria.

· Strong organizational and prioritization skills.

· Ability to manage multiple tasks and deadlines efficiently.

· Proficiency in Microsoft Office (Word, Excel, Outlook).

· Ability to use electronic medical records and authorization systems.

· Ability to learn and adapt to new software and technology.

· Strong attention to detail and accuracy.

· Ability to maintain confidentiality and professionalism.

· Ability to work independently and as part of a team.

· Ability to review and interpret clinical information and apply established criteria.

· Strong organizational and prioritization skills.

· Ability to manage multiple tasks and deadlines efficiently.

· Proficiency in Microsoft Office (Word, Excel, Outlook).

· Ability to use electronic medical records and authorization systems.

· Ability to learn and adapt to new software and technology.

· Strong attention to detail and accuracy.

· Ability to maintain confidentiality and professionalism.

· Ability to work independently and as part of a team.


PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented of those that must be met by an employee to successfully perform the essential functions of this job. Prolonged sitting, typing, and computer work. Occasional standing, walking, bending, and reaching. Ability to lift up to 20 pounds occasionally. Ability to concentrate for extended periods while reviewing clinical documentation. Ability to manage multiple priorities in a fast-paced environment. Ability to exercise sound clinical judgment and decision-making. Frequent interaction with healthcare providers and internal staff via phone and electronic communication. Low to moderate noise level consistent with office environment.


PAY RANGE

$35.00 - $40.00 / hourly

Apply