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Prior Authorization Registered Nurse Jobs (NOW HIRING)

OneOncology LLC

Prior Authorization Specialist

Huntsville, AL · On-site

$17.75 - $23.75/hr

Communicate with Physicians and RN's regarding treatment. * Check previous patient treatment with current treatment to ensure insurance payments and prior authorizations have been entered/approved.

Claim Health

Prior Authorization Specialist

New York, NY · On-site

$19.75 - $26.25/hr

Prior authorization is one of the largest operational bottlenecks for agencies. Our platform ... Comfortable working independently in a fast-moving startup Nice to Have * RN, LPN, or clinical ...

Equitas Health

Prior Authorization Specialist

Columbus, OH · On-site

$18.13 - $21.78/hr

Other duties as assigned by the Prior Authorization Supervisor, Director of Nursing, and Leadership ... Medical Assistant, Certified Pharmacy Technician or Registered Pharmacy Technician (must be ...

WomanCare Centers

Prior Authorization Nurse

Norfolk, VA · On-site

$25 - $31/hr

WomanCare Centers Prior Authorization Nurse We are a busy, patient-centered OB/GYN outpatient practice dedicated to providing compassionate, comprehensive care to women at every stage of life. Our ...

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How much do prior authorization registered nurse jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for prior authorization registered nurse 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 does a Prior Authorization Registered Nurse do?

A Prior Authorization Registered Nurse is responsible for reviewing healthcare service requests to determine if they meet the necessary criteria for insurance coverage before treatment is provided. This nurse works closely with physicians, insurance companies, and patients to ensure that required medical procedures, medications, or treatments are approved in advance. Their role involves interpreting clinical information, applying insurance guidelines, and assisting with documentation to facilitate timely patient care. They help prevent unnecessary delays and reduce denied claims by ensuring all required information is submitted for approval.

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

Prior Authorization Registered Nurses often encounter challenges such as navigating complex insurance guidelines, managing high volumes of requests, and ensuring timely approvals for patient care. To address these challenges, strong organizational skills, attention to detail, and effective communication with insurance companies and healthcare providers are essential. Many nurses also rely on electronic health record systems and standardized workflows to streamline processes and reduce delays, which helps maintain patient satisfaction and supports efficient team collaboration.

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

To thrive as a Prior Authorization Registered Nurse, you need a solid clinical background, strong knowledge of insurance guidelines, and a current RN license. Familiarity with authorization management systems, electronic health records (EHRs), and payer-specific software is typically required. Attention to detail, effective communication, and critical thinking are important soft skills for reviewing cases and collaborating with providers and insurers. These skills ensure accurate, timely authorization decisions, enhanced patient access to care, and compliance with regulatory standards.

What is the difference between Prior Authorization Registered Nurse vs Utilization Review Nurse?

AspectPrior Authorization Registered NurseUtilization Review Nurse
CredentialsRN license, certifications in case management or healthcareRN license, certifications in utilization review or case management
Work EnvironmentInsurance companies, healthcare providers, or managed care organizationsHospitals, insurance companies, or healthcare organizations
Job FocusReviewing and approving prior authorization requests for procedures and treatmentsAssessing medical necessity and reviewing patient records for ongoing care
Common UsageUsed in insurance and healthcare settings for authorization processesUsed in utilization management to ensure appropriate care

The main difference is that Prior Authorization Registered Nurses primarily review and approve requests for specific procedures before treatment, while Utilization Review Nurses evaluate ongoing patient care to determine medical necessity. Both roles require RN licensure and related certifications, but their focus and work settings differ slightly.

More about Prior Authorization Registered Nurse jobs

What cities are hiring for Prior Authorization Registered Nurse jobs?

Cities with the most Prior Authorization Registered Nurse job openings:

What states have the most Prior Authorization Registered Nurse jobs?

States with the most job openings for Prior Authorization Registered Nurse jobs include:

What job categories do people searching Prior Authorization Registered Nurse jobs look for?

The top searched job categories for Prior Authorization Registered Nurse jobs are:

Prior Authorization Registered Nurse jobs near you
Infographic showing various Prior Authorization Registered Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $87,868 per year, or $42.2 per hour.

Prior Authorization Nurse

Jefferson County Health Center

Fairfield, IA

Full-time

Posted 3 days ago

New

Jefferson County Health Center rating

9.1

Company rating: 9.1 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

14th of 1,064 rated hospitals

Job description

POSITION OVERVIEW (non-exempt):

The Prior Authorization Nurse plays a critical role in ensuring timely and accurate authorization of medical services across multiple specialties. This position serves as a liaison between providers, patients, and insurance companies to facilitate timely access to care while ensuring compliance with payer guidelines. The nurse utilizes clinical knowledge and judgment to evaluate medical necessity, gather supporting documentation, verifying insurance requirements and submitting prior authorization requests for multiple specialties. Working collaboratively with physicians, clerical staff, and other departments, the Prior Authorization Nurse helps streamline workflows, reduce delays in care, and optimize reimbursement.

QUALIFICATIONS:

  • Current Registered Nurse (RN) license in IA preferred. Licensed Practical Nurse (LPN) applicants with relevant prior authorization experience will also be considered
  • 2+ years of clinical nursing experience
  • Prior experience in utilization review, case management, or prior authorization preferred
  • Strong knowledge of payer policies and clinical criteria (e.g., InterQual, MCG)
  • Experience in one or more of the following specialties: oncology, radiology, infusion therapy, pain management procedures or surgical services
  • Experience with Microsoft Office, Excel and other web-based programs including CoverMyMeds
  • Excellent communication, organizational and time management skills

ACCOUNTABILITY: 

Reports to the Prior Authorization Manager and Revenue Cycle Director

DIRECT REPORTS:

None

POSITION-SPECIFIC REQUIREMENTS:

  • Review clinical documentation to determine medical necessity for requested services.
  • Submit prior authorization requests to insurance companies using payer-specific portals and Epic workflows.
  • Communicate with providers to obtain additional documentation or clarify orders as needed.
  • Track and follow up on pending authorizations to ensure timely responses.
  • Document all authorization activity in the electronic health record (Epic).
  • Collaborate with other team members to ensure complete and accurate submissions.
  • Stay current with payer guidelines, authorization requirements, and regulatory changes.
  • Escalate denials or delays to appropriate clinical or administrative leadership.
  • Coordinate and schedule peer-to-peer (P2P) reviews between providers and payers to address clinical denials.
  • Submit formal appeals for denied services, ensuring compliance with payer-specific guidelines and timelines
  • Participate in process improvement initiatives to streamline authorization workflows.
  • Perform additional responsibilities as requested by leadership to support departmental goals and hospital operations

WORK ENVIRONMENT:

  • Works in a well-illuminated, climate-controlled environment
  • May come in contact with hazardous chemical or treatment modalities
  • Possibility exists of exposure to communicable diseases
  • Involvement in inpatient care may result in unavoidable work-related illness or injury
  • Work environment is comfortable, with minimal exposure to physical hazards
  • Moderate to loud noise environment when machines/equipment in use
  • Involvement in checking in/moving of supplies may result in unavoidable work-related injury
  • Must be constantly alert for patient/family emergency situations

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