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Prior Authorization Review Jobs (NOW HIRING)

Mindlance

Prior Authorization Technician I

Philadelphia, PA · On-site

$17.75 - $21.50/hr

Utilizes member claims history during the prior authorization review process * Makes outbound calls to obtain additional information needed to process prior authorization requests * Submits ...

Della Infotech Inc.

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Prior Authorization Technician I

Philadelphia, PA · Remote

$27 - $29/hr

Utilizes member claims history during the prior authorization review process * Makes outbound calls to obtain additional information needed to process prior authorization requests * Submits ...

New

Oak St. Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

Oak St. Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

Oak St. Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

Oak St. Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

Oak St. Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

Oak St. Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

Oak St. Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

Oak St. Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

Oak St. Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

Oak St. Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

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How much do prior authorization review jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for prior authorization review in the United States is $20.89, according to ZipRecruiter salary data. Most workers in this role earn between $17.31 and $23.08 per hour, depending on experience, location, and employer.

What is a prior authorization review?

A Prior Authorization Review is a process used by health insurance companies to determine if a prescribed medical service, procedure, or medication will be covered under a patient's insurance plan. Before certain treatments or prescriptions are approved, the provider must submit specific documentation justifying the medical necessity. This review helps ensure that patients receive appropriate care while managing healthcare costs and preventing unnecessary procedures. The process can involve coordination between healthcare providers, insurance companies, and sometimes the patient.

What skills and qualifications are needed to thrive as a prior authorization review specialist?

To thrive as a Prior Authorization Review Specialist, you need a strong understanding of medical terminology, insurance guidelines, and healthcare regulations, typically supported by healthcare experience or related certifications. Familiarity with electronic medical record (EMR) systems, payer portals, and utilization management software is crucial. Attention to detail, effective communication, and problem-solving abilities help you navigate complex authorization processes and collaborate with providers and insurers. These skills ensure timely and accurate approvals, reducing delays in patient care and supporting organizational efficiency.

What are common challenges faced by prior authorization review specialists, and how are they addressed?

One of the main challenges in a Prior Authorization Review role is managing high volumes of requests while ensuring accuracy and compliance with payer guidelines. Specialists often need to interpret complex medical policies and coordinate with healthcare providers to gather necessary documentation, which requires strong communication and organizational skills. To address these challenges, teams typically rely on detailed training, standardized workflows, and collaboration with clinical and administrative staff. Staying current with changing insurance requirements and leveraging technology tools can also help streamline the process and reduce errors.

What are popular job titles related to Prior Authorization Review jobs?

For Prior Authorization Review jobs, the most frequently searched job titles are:

Infographic showing various Prior Authorization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 19% Part Time, 1% Temporary, and 2% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $43,459 per year, or $20.9 per hour.

Prior Authorization Review Pharmacy Technician

Manhattan, NY • On-site

MetroPlusHealth
Insurance Services • 1 - 5K employees
Learn more about MetroPlusHealthexternal

$19.25 - $23.50/hr

Other

Re-posted yesterday

MetroPlusHealth rating

6.7

Company rating: 6.7 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
About NYC Health + Hospitals
MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.
Position Overview:
The Prior Authorization Review Technician is responsible for inputting, providing notification for and reviewing prior authorization requests. The Prior Authorization Review Technician is also responsible for entering and auditing overrides input in the Pharmacy Adjudication system, answering member inquiries and assisting in all relevant Pharmacy department deliverables.
Work Shifts
9:00 AM - 5:00 PM
Duties & Responsibilities
  • Inputs all received medical and pharmacy benefit prior authorization requests into processing platforms, ensuring the accurate transcription of all information.
  • Reviews select prior authorization requests and provide recommendations in accordance with internal guidelines and review criteria.
  • Answers inquiries from members, providers, pharmacies, and other stakeholders received through the pharmacy call center.
  • Provides verbal notification of prior authorization decisions and enters accurate medication overrides into the pharmacy adjudication platform.
  • Performs audits of vendor-entered medication overrides in the pharmacy adjudication platform.
  • Assists with pharmacy case management activities.
  • Supports departmental quality improvement initiatives.
  • Answers all triaged inquiries related to MetroPlusHealth pharmacy and medical benefits.
Minimum Qualifications
  • Associate's degree and 3 years of experience as a Pharmacy Technician required; bachelor's degree preferred.
  • Or, a high school diploma/GED and 5 years of experience as a Pharmacy Technician required.
  • Pharmacy experience in a managed care environment preferred.
  • Auditing experience preferred.
  • Experience with government programs, including Medicare, Medicare Part D, and Medicaid, preferred.
  • Proficiency in Microsoft Word, Excel, and PowerPoint required.
  • Proficiency in Microsoft Access preferred.
Licensure and/or Certification Required:
  • Pharmacy Technician Certification Board (PTCB) or ExCPT Pharmacy Technician Certification, required
Professional Competencies:
  • Integrity and Trust
  • Customer Focus
  • Functional/Technical Skills
  • Position requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills

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