ZipRecruiter

Log In

1

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

KPC Global MSO

Authorization Specialist

Santa Ana, CA · On-site

$18.75 - $25/hr

SUMMARY Ensures timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned. Duties/Responsibilities: * Ensure timely ...

Oso Home Care

Director of Infusion Intake

Irvine, CA · On-site

$80K - $120K/yr

Oversee Benefits Investigation, Insurance Verification, Prior Authorization, Financial Clearance ... Ensure seamless coordination between Intake, Pharmacy, Nursing, Scheduling, Billing, Clinical ...

Oso Home Care

Director of Infusion Intake

Irvine, CA · On-site

$80K - $120K/yr

Oversee Benefits Investigation, Insurance Verification, Prior Authorization, Financial Clearance ... Ensure seamless coordination between Intake, Pharmacy, Nursing, Scheduling, Billing, Clinical ...

KPC Health

Authorization Specialist

Santa Ana, CA · On-site

$18.75 - $25/hr

Job Title Ensures timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned. Duties/Responsibilities * Ensure timely ...

Oso Home Care

Intake Coordinator - Full-Time

Irvine, CA · On-site

$26 - $33/hr

  • Medical

... nurses, reimbursement staff, and patients to ensure referrals are processed accurately, efficiently ... Determine prior authorization requirements based on payer guidelines and prescribed therapy.

Oso Home Care

Intake Coordinator - Full-Time

Irvine, CA · On-site

$26 - $33/hr

  • Medical

... nurses, reimbursement staff, and patients to ensure referrals are processed accurately, efficiently ... Determine prior authorization requirements based on payer guidelines and prescribed therapy.

Specialty Care Rx

Intake Specialist

Walnut, CA · On-site

$18.50 - $24.75/hr

... with the nursing, delivery, and pharmacy departments. Responsible for facilitating the timely ... eligibility and authorization status of insured prior to service being provided. 4. Ensures ...

Oso Home Care

Reimbursement Specialist

Irvine, CA · On-site

$25 - $31/hr

Review claims for completeness and accuracy prior to submission. * Ensure claims are billed within ... Collaborate with Intake, Authorization Specialists, Pharmacy, Nursing, and physician offices to ...

Oso Home Care

Reimbursement Specialist

Irvine, CA · On-site

$25 - $31/hr

Review claims for completeness and accuracy prior to submission. * Ensure claims are billed within ... Collaborate with Intake, Authorization Specialists, Pharmacy, Nursing, and physician offices to ...

Oso Home Care

Major Medical Collector HYBRID

Irvine, CA · On-site

$21 - $33.15/hr

  • Medical

Pharmacy and nursing billing requirements. * HCPCS, CPT, ICD-10-CM, modifiers, revenue codes, and NDC billing. * Medical necessity guidelines. * Prior authorization requirements. * Explanation of ...

Oso Home Care

Major Medical Collector HYBRID

Irvine, CA · On-site

$21 - $33.15/hr

  • Medical

Pharmacy and nursing billing requirements. * HCPCS, CPT, ICD-10-CM, modifiers, revenue codes, and NDC billing. * Medical necessity guidelines. * Prior authorization requirements. * Explanation of ...

Kaizen Stackup

Account Executive Healthcare

Irvine, CA · On-site

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive Healthcare

Brea, CA

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive Healthcare

Santa Ana, CA · On-site

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive Healthcare

Santa Ana, CA · On-site

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive Healthcare

Irvine, CA

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive Healthcare

Irvine, CA

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

previous pagenext page

Showing results 21-40

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 12, 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 August 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.

Physician Internal Medicine - Competitive Salary

Inspire Healthcare

Pomona, CA • Remote

$250K - $350K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 22 days ago

Job description

We are seeking a Remote Medical Director for a non-clinical role focused on prior authorization and medical necessity reviews. No direct patient care is required. Candidates must reside in the LAarea and be available for occasional on-site meetings and trainings.

Responsibilities
  • Review prior authorization requests and determine medical necessity using evidence-based clinical guidelines.
  • Approve, deny, modify, or redirect services as appropriate.
  • Collaborate with nurses, physicians, and care management teams to support high-quality, cost-effective care.
  • Participate in appeals, grievance reviews, retrospective claims reviews, and quality improvement initiatives.
  • Serve as a clinical resource to providers on utilization management and patient care issues.
Qualifications
  • MD or DO degree required.
  • Board Certification in Internal Medicine strongly preferred.
  • Minimum 5 years of clinical experience required.
  • 2+ years of managed care, health plan, or utilization management experience preferred.
  • Strong knowledge of prior authorization processes and medical necessity criteria.
  • Excellent communication, organizational, and decision-making skills.
  • Proficiency with Microsoft Office and remote work technology.
Compensation & Benefits
  • Salary: $250,000"$350,000 annually DOE.
  • Comprehensive benefits package including medical, dental, vision, 401(k), paid time off, life insurance, FSA, tuition reimbursement, CME/license reimbursement, and employee assistance programs.

This is an excellent opportunity to join one of Southern California's fastest-growing physician organizations in a leadership role that supports quality patient care while maintaining work-life balance.

Apply