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Prior Authorization Rn Jobs (NOW HIRING)

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Prior-Authorization Technician- Pharmacy

Arlington, VA · On-site

$23.46 - $30.50/hr

Position Summary The Prior Authorization Technician will process prior authorizations and locate ... Certified Nurse Assistant, Medical Assistant, Licensed Practical Nurse) will be considered Physical ...

Guided Care

Prior Authorization Case Manager

Brooklyn, NY · On-site

$55K - $65K/yr

Prior Authorization Case Manager The Prior Authorization Case Manager obtains prior authorizations ... Skilled nursing admissions or business office experience preferred. * Independent and self ...

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Prior Authorization RN information

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How much do prior authorization rn jobs pay per hour?

As of Jul 15, 2026, the average hourly pay for prior authorization rn in the United States is $42.24, according to ZipRecruiter salary data. Most workers in this role earn between $31.49 and $50.00 per hour, depending on experience, location, and employer.

What do prior authorization nurses do?

Prior authorization nurses review medical documentation and communicate with healthcare providers and insurance companies to obtain approval for specific treatments, medications, or procedures. They ensure that requests meet insurance criteria, often using electronic health records and authorization systems, to facilitate timely patient care.

How to make 150,000 as a nurse?

A Prior Authorization RN can earn $150,000 by gaining extensive experience, obtaining relevant certifications, and working in high-paying settings such as specialty clinics or insurance companies. Advancing to senior or managerial roles, working overtime, or taking on consulting opportunities can also increase earning potential.

What is the difference between Prior Authorization Rn vs Medical Coder?

AspectPrior Authorization RnMedical Coder
CredentialsRN license, possibly certifications in case management or utilization reviewCertification in coding (CPC, CCS), no RN license required
Work EnvironmentHospitals, insurance companies, healthcare facilitiesMedical offices, hospitals, insurance companies
Primary ResponsibilitiesReviewing and obtaining prior authorizations for treatments and proceduresTranslating medical records into coded data for billing and documentation

While both roles are integral to healthcare administration, the Prior Authorization RN focuses on obtaining approvals for patient care, requiring nursing credentials and clinical knowledge. In contrast, Medical Coders specialize in coding medical records for billing, emphasizing coding certifications. Understanding these differences helps healthcare professionals and job seekers identify the right career path or job opportunity.

What are the key skills and qualifications needed to thrive as a Prior Authorization RN, and why are they important?

To thrive as a Prior Authorization RN, you need a current RN license, strong clinical assessment skills, and a solid understanding of insurance guidelines and medical necessity criteria. Familiarity with utilization management software, electronic health records (EHRs), and payer-specific authorization systems is essential. Exceptional attention to detail, critical thinking, and effective communication help you advocate for patients and collaborate with healthcare providers and insurers. These skills ensure the efficient processing of authorizations, reduce delays in care, and support patients in receiving appropriate treatments.

What Does a Prior Authorization RN Do?

A prior authorization RN is a registered nurse who assesses applications for specific treatments, medical procedures, and medications. In this job, you review each request for medical coverage and determine the necessity or potential benefits of the treatment or medicine. You assess patient information and other factors to decide whether or not to authorize coverage. Your duties as a prior authorization RN also include reviewing denials of benefits and seeking additional information that could alter the initial decision. You document your findings for each case and present the evidence along with your decision. It is your job to review the case for each patient thoroughly while following all government regulations and healthcare provider policies.

What are some common challenges faced by Prior Authorization RNs, and how can they be addressed?

Prior Authorization RNs often navigate complex insurance guidelines and manage high volumes of requests, which can be challenging due to frequent policy updates and tight timelines. Staying organized, maintaining up-to-date knowledge of payer requirements, and leveraging electronic health record (EHR) systems can help streamline the process. Collaboration with providers and insurance representatives, as well as ongoing training, are essential for efficiently resolving issues and ensuring timely patient care.

How to make $300,000 as a nurse?

A Prior Authorization RN can increase earnings by gaining specialized certifications, working in high-paying healthcare settings, or taking on overtime and extra shifts. Developing expertise in insurance processes and healthcare regulations can also lead to higher-paying roles or consulting opportunities.

How to make an extra 2000 a month as a nurse?

A Prior Authorization RN can increase income by taking on overtime shifts, working in high-demand specialties, or obtaining certifications to qualify for higher-paying roles. Additionally, freelance consulting or remote review work can provide supplementary income outside regular hours.

What is a Prior Authorization RN?

A Prior Authorization RN is a registered nurse who specializes in reviewing and processing prior authorization requests for medical procedures, medications, or treatments. They evaluate clinical documentation to determine if requests meet insurance or regulatory criteria and often serve as a liaison between healthcare providers, patients, and insurance companies. Their role helps ensure that care is medically necessary and covered by the patient's health plan, streamlining access to important healthcare services while controlling costs.
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Prior Authorization RN jobs near you
Infographic showing various Prior Authorization Rn job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 88% Full Time, 10% Part Time, and 1% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,868 per year, or $42.2 per hour.
Prior Authorization Representative

Prior Authorization Representative

Orsini Healthcare

Elk Grove Village, IL • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 5 days ago

Job description

Careers with real impact.

Every role at Orsini moves a patient closer to life-changing therapy. We partner with biopharma innovators, healthcare providers, and payers to make access simple, compassionate, and reliable - so no patient is left behind. Make your next role matter.
ABOUT ORSINI

Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behindâ„¢

OUR MISSION

Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.  

CORE VALUES

At the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.  

COMPENSATION & LOCATION

The compensation range for this role is $23.00/hour.

This a hybrid position based out of our Elk Grove Village, Illinois location requires 2-3 days in office. Travel to other locations may occur, although minimal.
POSITION SUMMARY
This position will work closely with the Benefits Verification Team to validate patient’s insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical policies. Prior Authorization Representatives are responsible for contacting physician’s offices to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans. 
ESSENTIAL DUTIES

  • Contact plans (PBM or Major Medical) to validate requests sent from BV
  • Contact physician offices to obtain current prescriptions and required clinical documentation
  • Validate that received clinical documentation meets plan requirements
  • Initiate prior authorizations through CoverMyMeds and follow up on all pending PAs within 48 hours
  • Respond to urgent requests from the Patient Care Coordinator Team or Program Manager in a timely manner
  • Obtain approval and denial letters
  • Submit new and re-authorizations through the Complex audit process
  • Initiate re-authorizations 30 days prior to expiration
  • Ability to meet daily key performance indicators (KPIs) in a fast-paced environment
  • Strong attention to detail with a willingness to go the extra mile
  • Ability to multitask and manage priorities effectively
  • Flexibility to work overtime as needed
  • Other duties as assigned

Disclaimer: The information written in this job description indicates the general nature and level of work to be performed. This job description is not designed to contain or be interpreted as totally comprehensive of every job duty, responsibility, or qualification required by an employee assigned to this job. While employed in this position, an employee may be required to perform other assignments not listed in this job description.  


KNOWLEDGE, SKILLS, AND TRAINING

  • Experience with Major Medical Insurance. 
  • Knowledge of Pharmacy Benefit. 
  • Knowledge of HCPC Codes (J-Codes). 
  • Knowledge of ICD-10 Codes (Diagnoses Codes). 
  • Familiar with medical documentation such as H&P’s, Genetic testing, etc. 
  • Ability to read prescriptions. 
  • Ability to convert a prescription into an authorization request based on payer requirements. 
  • Ability to interpret medical policies. 
  • Proficiency in Microsoft Office (including Excel/TEAMS)
  • Strong data entry and quality assurance skills with attention to detail
  • Ability to multitask in a fast-paced environment
  • Self-starter with strong organizational skills


EMPLOYEE BENEFITS

  • Medical Coverage, Dental, and Vision Coverage
  • 401(k) with employer match
  • Accident and Critical Illness coverage
  • Company-paid life insurance options
  • Generous PTO, paid holidays, and floating holidays
  • Tuition reimbursement program.

Equal Employment Opportunity

Orsini Rare Disease Pharmacy Solutions is committed to the principle of Equal Employment Opportunity for all employees and applicants. It is our policy to ensure that both current and prospective employees are afforded equal employment opportunity without consideration of race, religious creed, color, national origin, nationality, ancestry, age, sex, marital status, sexual orientation, or present or past disability (unless the nature and extent of the disability precludes performance of the essential functions of the job with or without a reasonable accommodation) in accordance with local, state and federal laws.

Americans with Disabilities Act

Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.

E-Verify Participation Notice

We participate in the federal E-Verify program to confirm the identity and employment eligibility of all newly hired employees.

All offers of employment are contingent upon the successful completion of Form I-9 and verification through the E-Verify system.

For more information about E-Verify, please review the official notices below:

E-Verify Participation Poster (English & Spanish):
https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf

Right to Work Poster (English & Spanish):
https://www.e-verify.gov/sites/default/files/everify/posters/IER_RightToWorkPoster.pdf

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