ZipRecruiter

Log In

1

Prior Authorization Rn Jobs in Arizona (NOW HIRING)

Arizona Priority Care

Prior Auth RN

Chandler, AZ

The Prior Authorization Registered Nurse (RN) is responsible for conducting initial clinical reviews of preservice authorization requests, focusing on continuity of care and the proper utilization of ...

GI Alliance

Registered Nurse (RN) (31876)

Phoenix, AZ · On-site

... prior authorizations, disability paperwork, and other patient care coordination needs. * Maintain ... Current Arizona RN license in good standing required. * Current CPR certification required.

GI Alliance

Registered Nurse (RN) (31876)

Phoenix, AZ · On-site

... prior authorizations, disability paperwork, and other patient care coordination needs. * Maintain ... Current Arizona RN license in good standing required. * Current CPR certification required.

next page

Showing results 1-20

All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Arizona

Prior Authorization Rn information

See Arizona salary details

$6

$39

$67

How much do prior authorization rn jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for prior authorization rn in Arizona is $39.37, according to ZipRecruiter salary data. Most workers in this role earn between $29.33 and $46.59 per hour, depending on experience, location, and employer.

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.

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.
More about Prior Authorization Rn jobs
What are popular job titles related to Prior Authorization Rn jobs in Arizona? For Prior Authorization Rn jobs in Arizona, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Rn jobs in Arizona look for? The top searched job categories for Prior Authorization Rn jobs in Arizona are:
Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in Arizona as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, 1% Temporary, and 3% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $81,883 per year, or $39.4 per hour.

Prior Auth RN

Arizona Priority Care

Chandler, AZ

Full-time

Posted 20 days ago

Job description

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 12 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Prior Authorization Registered Nurse (RN) is responsible for conducting initial clinical reviews of preservice authorization requests, focusing on continuity of care and the proper utilization of services. Reporting to the Director of Clinical Services Operations, the RN plays a crucial role in the Utilization Management process by conducting historical research, identifying appropriate criteria, and drug dosing to prepare cases for UM reviewers. This position involves collaboration with the PA staff and senior leadership to ensure efficient daily operations. Additionally, the RN will participate in process improvements, train new hires, and maintain compliance with internal policies and regulatory standards.

POSITION DUTIES & RESPONSIBILITIES

  • Monitor the PA Nurse and Pharmacy Request queues as directed by prior authorization management, ensuring timely processing of Routine/Standard and Urgent/Expedited prior authorizations in compliance with regulatory and health plan requirements.
  • Assist in the PA Clinical Review process by pre-screening authorization requests to ensure all necessary information is provided. If documentation is insufficient, actively obtain the required information to facilitate timely decision-making.
  • Review requested services and apply the relevant health plan criteria hierarchy to locate guidelines that support the medical director in assessing medical necessity.
  • Conduct clinical reviews for Prior Authorization (PA) Nursing in accordance with AZPC policies, applying relevant guidelines and criteria to determine the medical necessity of requested services, and approve requests when appropriate.
  • Prepare authorization requests requiring review by Medical Directors, ensuring adherence to the appropriate SBAR (Situation, Background, Assessment, Recommendation) framework, Utilization Management review hierarchy, inclusion of necessary denial language, and completion of any additional research as required.
  • Compose medical necessity denial letters using pre-service denial formats that comply with health plan and CMS requirements. Ensure adherence to all regulatory guidelines, including timely submission, and maintain clarity with a Flesch-Kincaid score of less than 8, while avoiding spelling and grammatical errors.
  • Process a minimum of 20 prior authorization requests daily, depending on the complexity of each request.
  • Achieve and maintain a clinical review accuracy rate of 98% or higher, ensuring high-quality assessments throughout the review process.
  • Act as a liaison between the Medical Director and providers to address prior authorization concerns and inquiries.
  • Maintains up-to-date knowledge of regulatory requirements established by CMS, NCQA, and Health Plans, including compliance standards and the defined scope of practice.
  • Identify cases involving potential or actual medically inappropriate interventions and refer them to the Medical Director for review.
  • Identify cases involving potential or actual medically inappropriate interventions and refer them to the Medical Director for review.
  • Identify and report any potential quality of care issues to the Quality Department.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in Arizona Priority Care Policies and Procedures relating to HIPAA compliance.
  • Provides excellent customer service skills with internal and external incoming and outgoing phone calls.
  • Interacts professionally and communicates clearly with staff, other departments, management, providers, and members.
  • Demonstrate flexibility to adjust to work assigned based on competing demands of the organization.
  • Collaborate with the Quality department to conduct thorough reviews of medical records, ensuring compliance with standards and identifying potential areas for improvement.
  • Assist in analyzing member surveys to gather insights on quality of care and patient satisfaction.
  • Support the identification and investigation of potential quality issues to promote continuous improvement in services.
  • Other duties as assigned by management.

EDUCATION, TRAINING AND EXPERIENCE

  • Graduated from an accredited Registered Nurse Program.
  • Current unrestricted AZ RN License.
  • Minimum of 3 years acute care or care management experience.
  • Knowledge of Medicare, state and local managed care regulations, prior experience in Managed Care setting preferred.
  • Strong knowledge of Continuum of Care, Care Planning, Transitions of Care and Inner-disciplinary Care Team structures and functionality.
  • Prior experience with record review and knowledge of record documentation standards.
  • Exceedingly detail-oriented, able to function under pressure and prioritize and re-prioritize tasks as needed.
  • Exceptional organizational and project management skills including strong attention to accuracy.
  • Exceptional interpersonal, verbal and written communication skills, including proofreading and grammar skills.
  • Able to communicate effectively and in professional manner with all levels of internal staff and external customers.
  • Ability to work both independently and as part of a team, with minimal supervision.
  • Proficient ability with multiple Microsoft Office applications (Word, Outlook, Excel, Power Point, etc.) and work within electronic health records systems, including NextGen and EzCap.

Pay Range: $40.00 – $42.00/hour

  • *This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period.*