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Prior Authorization Review Nurse Jobs (NOW HIRING)

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 ...

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 ...

Varite

Registered Nurse

As a Prior Authorization Nurse, you work outside the walls of a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong ...

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 ... For further information, please review the Know Your Rights notice from the Department of Labor.

US Tech Solutions

Registered Nurse

Baton Rouge, LA · On-site

As a Prior Authorization Nurse, you work outside the walls of a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong ...

TriHealth

Prior Authorization Specialist

Cincinnati, OH · On-site

$17.25 - $23/hr

Review medical record to obtain necessary patient demographic and clinical information and seek timely clarification from pharmacist or physician as necessary * Review Prior Authorization denials and ...

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Prior Authorization Review Nurse information

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$17

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$65

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

As of Aug 13, 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, 79% Full Time, 17% 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.

Prior Authorization Coordinator

PainPoint

Remote

$19 - $21/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Job description

Prior Authorization Coordinator
Full-Time | $19-21/hour | Monday-Friday | 8:00 AM-4:30 PM CST
Location: Remote
About DxTx Pain & Spine
At DxTx Pain & Spine, we're redefining how pain and spine practices thrive. As a physician-aligned partner organization, we empower independent, award-winning physicians across the country by combining clinical autonomy with strong operational support.
The Opportunity
As a Prior Authorization Coordinator, you'll play a vital role in ensuring patients receive timely approval for the care they need. You'll manage the entire authorization process for interventional pain management procedures-supporting both office-based and advanced outpatient treatments. This role is ideal for someone detail-oriented, collaborative, and dedicated to process accuracy and patient impact.
What You'll Do:
Authorization Management & Compliance
  • Monitor advanced procedure trackers for each practice to identify authorization opportunities.
  • Collect all required documentation for prior authorizations.
  • 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 claim information to ensure efficient claim processing.
  • Identify trends or issues that delay authorization or claims processing.
Collaboration & Communication
  • Communicate with practices, vendors, insurance companies, patients, and management to secure necessary approvals.
  • Provide the highest level of customer service to internal teams.
  • Serve as a backup to the Contact Center Team during peak scheduling call times.
  • Perform other related duties as assigned to support smooth operations and patient care continuity.
You'll Thrive in This Role If You...
  • Excel at organization, accuracy, and time management.
  • Communicate clearly and professionally-both verbally and in writing.
  • Are a proactive problem-solver who enjoys navigating complex processes.
  • Value teamwork, adaptability, and supporting patient-centered care.
  • Are comfortable working remotely in a fast-paced, detail-driven environment.
Qualifications
  • High School Diploma or GED (required)
  • Minimum of 1 year of prior authorization and clinical setting experience (required)
  • Experience working within Pain Management required
  • Proficient in Microsoft Office Suite
  • Strong analytical and problem-solving abilities
  • Excellent organizational skills and attention to detail
  • Knowledge of HIPAA privacy and security requirements
  • Basic understanding of medical terminology
  • Familiarity with payor portals and medical policy navigation
  • Must be able to sit for extended periods, communicate clearly, perform computer-based tasks, occasionally lift up to 25 lbs, and maintain close vision, depth perception, and focus adjustment.
What We Offer
  • Health, Dental & Vision Insurance
  • Accident and Life/AD&D Insurance
  • Short & Long-Term Disability
  • Emergency Travel Assistance Program
  • ID-theft Protection Services
  • LifeMart Employee Discount Program
  • Health Savings Account (HSA)
  • Health Management Tools
  • Paid Time Off (PTO)
  • Company Paid Holidays
  • Paternal Leave
  • 401(k) Retirement Plan
  • Remote Stipend
  • Travel Reimbursement
  • Continuing Education Reimbursement
  • Bonusly (employee recognition platform)
  • DailyPay (on-demand pay access)
Why You'll Love Working at DxTx Pain & Spine
At DxTx, you'll join a supportive, mission-driven team that values transparency, innovation, and growth. You'll have the opportunity to contribute to a national network that's transforming pain care-while enjoying the flexibility of remote work and the satisfaction of meaningful impact.
Ready to Make a Difference?
If you're detail-driven, patient-focused, and eager to play a key role in delivering exceptional pain care, we'd love to hear from you.
An Equal Opportunity Employer
We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.

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