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Prior Authorization Review Nurse Jobs (NOW HIRING)

Leon Health, Inc.

Concurrent Review Nurse

Miami, FL · On-site

Oversee the quality, accuracy, and timeliness of prior authorization reviews and ensure appropriate ... Bachelor's degree in Nursing required Experience * Minimum of two (2) years of experience in ...

Managed Staffing

Prior Authorization Techician

RI · Remote

$21 - $22/hr

Document reviews accurately, completely, and in a timely manner. * Transfer all clinical questions ... are, PBM, or Prior Authorization related. - This experience must be clearly visible on the ...

PainPoint

Prior Authorization Coordinator

Atlanta, GA · On-site +1

$19 - $21/hr

Review medical necessity guidelines for procedures by Paycor. * Accurately and promptly submit prior and retro authorization requests to payors. * Document account activity, updating patient and ...

PainPoint

Prior Authorization Coordinator

$19 - $21/hr

Review medical necessity guidelines for procedures by Paycor. * Accurately and promptly submit prior and retro authorization requests to payors. * Document account activity, updating patient and ...

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Prior Authorization Review Nurse information

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$38

$65

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

As of Aug 8, 2026, the average hourly pay for prior authorization review nurse in the United States is $38.62, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $43.27 per hour, depending on experience, location, and employer.

What are some common challenges faced by Prior Authorization Review Nurses, and how can they be managed?

Prior Authorization Review Nurses often encounter challenges such as navigating complex insurance policies, staying updated with frequently changing payer requirements, and managing high volumes of authorization requests. Effective communication with physicians, patients, and insurance representatives is crucial to ensure timely and accurate approvals. Staying organized, leveraging electronic health record systems, and participating in ongoing training can help manage these challenges and support efficient workflow in this fast-paced environment.

What does a Prior Authorization Review Nurse do?

A Prior Authorization Review Nurse is a registered nurse who evaluates medical requests from healthcare providers to determine if certain procedures, medications, or treatments qualify for insurance coverage. They review medical records, guidelines, and insurance policies to ensure requests meet necessary criteria. Their role is crucial in helping patients receive appropriate care while ensuring adherence to insurance requirements and cost management. They often communicate with providers, patients, and insurance companies to clarify or obtain additional information as needed.

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

To thrive as a Prior Authorization Review Nurse, you need a strong clinical background as a registered nurse (RN), in-depth knowledge of medical terminology, and experience with utilization management. Familiarity with prior authorization software, electronic health records (EHRs), and payer guidelines is typically required, along with certification such as CCM or CPUR being advantageous. Exceptional attention to detail, analytical thinking, and effective communication skills help in evaluating requests and coordinating with providers and insurers. These skills ensure accurate review processes, timely approvals or denials, and compliance with regulatory standards, ultimately supporting patient care and organizational efficiency.

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

AspectPrior Authorization Review 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 third-party review organizationsHospitals, insurance companies, or healthcare facilities
Primary FocusReview and approve prior authorization requests for specific treatments or proceduresAssess overall medical necessity and appropriateness of care during utilization review

While both roles involve reviewing patient care, the Prior Authorization Review Nurse primarily focuses on approving specific treatment requests before services are provided, whereas the Utilization Review Nurse evaluates the overall necessity and efficiency of ongoing care. Both roles require nursing credentials and work within healthcare or insurance settings, but their specific responsibilities differ in scope and timing.

More about Prior Authorization Review Nurse jobs
What states have the most Prior Authorization Review Nurse jobs? States with the most job openings for Prior Authorization Review Nurse jobs include:
What job categories do people searching Prior Authorization Review Nurse jobs look for? The top searched job categories for Prior Authorization Review Nurse jobs are:
Prior Authorization Review Nurse jobs near you
Infographic showing various Prior Authorization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Clinical Review Nurse - Prior Authorization Various, NV

ESR Healthcare

Remote

$44/hr

Other

Posted 5 days ago

Job description

Clinical Review Nurse - Prior Authorization Various, NV

Clinical Review Nurse - Prior Authorization

Various, NV

All On-site

Location: Fully Remote – Prefer Candidates reside in NV, but can reside elsewhere if they have an NV RN License.

SHIFT: Training schedule is 3 weeks M-Fri 8AM-5PM PSt time ON CAMERA - NO TIME OFF

Work Schedule after training: M-Fri 8AM-5PM PST time

Duration: 3 months, Possibility to extend and/or convert to FTE

Start Date: 3/9/2026

Description: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.

Responsibilities:

  • Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
  • Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
  • Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member
  • Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care
  • Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities
  • Collects, documents, and maintains all members clinical information in health management systems to ensure compliance with regulatory guidelines
  • Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members
  • Provides feedback on opportunities to improve the authorization review process for members
  • Performs other duties as assigned

Candidate Requirements

Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.

Knowledge of Medicare and Medicaid regulations preferred.

Knowledge of utilization management processes preferred.

Required: Requires Graduate from an Accredited School of Nursing RN/LPN or Bachelors degree in Nursing and 2 – 4 years of related experience.

Preferred:

Required: MUST BE RN, Must Live in Nevada

MUST HAVE A NV LICENSE Preferred:

Years of experience required: MUST HAVE 2-4 years experience in health prior authorizations, case management, medical terminology/hipaa guidelines,

Disqualifiers: job hopping (want someone that will eventually be permanent at the client if the position comes available within department) PLEASE STATE IF CONTRACT ROLE.

Additional qualities to look for: Trucare, interqual

Top 3 must-have hard skills stack-ranked by importance

  • 1 Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred/analytical and critical thinking skills/problem solving/attention to detail
  • 2 Knowledge of Medicaid regulations preferred.
  • 3 Knowledge of utilization management processes preferred.

Pay Rate: up to $44/hr. ***

Working Place: Nevada, Nevada, United States

Company: ESR Healthcare

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