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Prior Authorization Nurse Jobs in Romeoville, IL

ReliaMed

Prior Authorization Specialist

Aurora, IL · On-site

$19.50 - $21.50/hr

Prior Authorization Specialist Since our doors opened in 1989, Reliable Medical has been committed to improving the lives of all who entrust us with their care and those who we entrust to provide it.

AltaStaff

UM Care Review Clinician

Chicago, IL · On-site

$40 - $42/hr

Must have 2-3 years of Prior Authorization OR Med-Surg experience; Familiarity with Inpatient Medical Necessity * Must have solid experience within a clinical setting as RN's must be able to use ...

Clarity Clinic

Utilization Review Clinician

Chicago, IL · On-site

Prior Authorization for Admission: * Review clinical documentation against payor medical necessity ... Active, unrestricted Illinois license: LCSW, LCPC, LMFT, or RN. * 2 or more years of post licensure ...

Clarity Clinic

Utilization Review Clinician

Chicago, IL · On-site

Prior Authorization for Admission: * Review clinical documentation against payor medical necessity ... Active, unrestricted Illinois license: LCSW, LCPC, LMFT, or RN. * 2 or more years of post licensure ...

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All JobsPrior Authorization Nurse JobsPrior Authorization Nurse Jobs in Romeoville, IL

Prior Authorization Nurse information

See Romeoville, IL salary details

$17

$39

$66

How much do prior authorization nurse jobs pay per hour?

As of Aug 31, 2026, the average hourly pay for prior authorization nurse in Romeoville, IL is $39.37, according to ZipRecruiter salary data. Most workers in this role earn between $30.14 and $44.13 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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What job categories do people searching Prior Authorization Nurse jobs in Romeoville, IL look for?

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What cities near Romeoville, IL are hiring for Prior Authorization Nurse jobs?

Cities near Romeoville, IL with the most Prior Authorization Nurse job openings:

Prior Authorization Nurse jobs near you
Infographic showing various Prior Authorization Nurse job openings in Romeoville, IL as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, 2% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $81,896 per year, or $39.4 per hour.

Prior Authorization Specialist

Matteson, IL • On-site

Keystone Advisors LLC
See more jobs at Keystone Advisors LLCexternal

$17.75 - $23.75/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 18 days ago

Job description

Keystone Advisors is looking for a Prior Authorization Specialist to join our team in Matteson, IL supporting one of our healthcare clients.
Job Summary
The Prior Authorization Specialist is responsible for obtaining and processing all prior authorization requests, coordinating phone calls, entering and tracking data from insurance providers and health plans regarding authorization, expedited reviews, and appeals. The Prior Authorization Specialist is required to document and track all communication attempts with insurance providers and health plans, follow up on all denials while working to ensure services are validated.
Typical Duties
  • Reviews accounts, and initiate pre-authorizations, and other requirements related to managed care; route to appropriate departments as needed.
  • Collects demographic, insurance, and clinical information to ensure that all reimbursement requirements are met.
  • Notifies the necessary parties within the required timeframe for routine and urgent requests for services.
  • Assists in monitoring utilization services to assure cost effective use of medical resources through processing prior authorizations.
  • Communicates with patients and/or referring physicians on non-covered benefits or procedure coverage issues.
  • Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
  • Provides consistent and comprehensive information (both in writing and verbally) to facilitate approvals.
  • Ensures insurance carrier documentation requirements are met and authorization documentation is entered and recorded in the patient's records.
  • Appeals pre-authorization denials and/or set-up peer to peer reviews.
  • Maintains an extensive working knowledge and expertise of insurance companies and billing authorization requirements.
  • Identifies and reports undesirable trends and reimbursement modeling errors or underlying causes of incorrect payment; review allowed variances from third party payers.
  • Builds and maintains working relationships with staff, referral sources, insurance companies, and medical providers.

Minimum Qualifications
  • High School diploma or GED equivalent with five (5) years of prior authorization experience OR Bachelor's degree with two (2) years of prior authorization experience
  • Three (3) years of experience processing insurance requests to obtain prior authorization
  • Experience and familiarity with using insurance portals, i.e., Anthem, Availty, Evicor, Covermymeds, Magellang

Preferred Qualifications
  • Knowledge and experience with payer processes to submit appropriate clinical documentation
  • Experience using Medical Terminology

Knowledge, Skills, Abilities and Other Characteristics
  • Proficiency with Microsoft applications and internet-based programs
  • Strong interpersonal skills with the ability to establish strong working relationships
  • Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
  • Strong time management skills to prioritize assignments and meet the designated deadline
  • Ability to anticipate, recognize, and meet the needs of the patients and their families
  • Ability to work in a team-based environment to accomplish goals and objectives
  • Ability to demonstrate respect and sensitivity for cultural diversity in client's work force and patient population
  • Ability to critically think, problem solve and make independent decisions supporting the authorization process, including interactions with payer representatives, physicians, and hospital case managers

Compensation Package:
  • Competitive Salary
  • Paid Time Off
  • Health, Vision & Dental Insurance
  • Health Savings Account (HSA)
  • Flexible Spending Account (FSA)
  • Short & Long Term Disability
  • 401 (K) with company match
  • Life Insurance

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