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Prior Authorization Rn Jobs in Arizona (NOW HIRING)

Medasource

Prior Authorization RN Reviewer

Phoenix, AZ · On-site

The Prior Authorization RN is responsible for reviewing and processing medical prior authorization requests to ensure services are medically necessary, meet evidence-based guidelines, and align with ...

Banner Health

RN Medical Management

Phoenix, AZ · Remote

Prior Authorization Work Shift: Day Job Category: Clinical Care Better Than Ever for Nurses. At ... As a RN Medical Management , you will focus on prior authorization. In this desk-based role, you ...

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.

Apolis

Grievance and Appeals Nurse

Phoenix, AZ · On-site

$40/hr

... * RN or LPN with an active, unrestricted Arizona nursing license. * Associate's degree in Nursing/Healthcare or Nursing Diploma. * 5+ years of experience in grievances/appeals, prior authorization ...

UHS

Intake RN - PRN Night Shift

Scottsdale, AZ · On-site

The Intake RN also at times be responsible for the verification and prior authorization of insurance benefits as needed. Qualifications Job Requirements: * Current license to practice nursing in ...

CVS Health

Registered Nurse-OSH

Tucson, AZ

$54K - $116K/yr

Registered Nurse Company: Oak Street Health Role Description: The purpose of a Registered Nurse at ... prior authorizations. * Conduct thorough and accurate reviews of patient medications and update as ...

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How much do prior authorization rn jobs pay per hour?

As of Sep 1, 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 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.

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 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 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 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.

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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, 77% Full Time, 19% Part Time, 1% Temporary, and 2% 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 Authorization RN Reviewer

Medasource

Phoenix, AZ • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

POSITION SUMMARY: The Prior Authorization RN is responsible for reviewing and processing medical prior authorization requests to ensure services are medically necessary, meet evidence-based guidelines, and align with the health plan’s policies. This RN plays a critical role in supporting cost-effective care while ensuring quality and compliance in alignment with regulatory and accreditation standards.


CORE FUNCTIONS

1. Manages health Plan consumer/beneficiaries across the health care continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes.


2. Provides pre-service determinations, concurrent review, and case management functions within Medical Management. Ensures quality of service and consistent documentation.


3. Works collaboratively with both internal and external customers in assisting health Plan consumers/beneficiaries and providers with issues related to prior authorization, utilization management, and/or case management. Meets internal and external customer service expectations regarding duties and professionalism.


4. Performs transfer of accurate, pertinent patient information to support the pre-service determination(s), the transition of patient care needs through the continuum of care, and performs follow-up calls for advanced care coordination. Documents accurately and timely, all interventions and necessary patient-related activities in the correct medical record.


5. Evaluates the medical necessity and appropriateness of care, optimizing health Plan consumer/beneficiary outcomes. Identifies issues that may delay patient services and refers to case management, when indicated, to facilitate resolution of these issues, pre-service, concurrently, and post-service.


6. Provides ongoing education to internal and external stakeholders who play a critical role in the continuum of care model. Training topics consist of population health management, evidence-based practices, and all other topics that impact medical management functions.


7. Identifies and refers requests for services to the appropriate Medical Director and/or other physician clinical peer when guidelines are not clearly met. Conducts call rotation for the health plan, as well as departmental call rotation for holidays.


8. Maintains a thorough understanding of each plan, including the Evidence of Coverage, Summary Plan Description, authorization requirements, and all applicable federal, state, and commercial criteria, such as CMS, MCG, and Hayes.


Minimum Qualifications:

  • Active RN license -- AZ License or Compact State License
  • Experience working in inpatient & outpatient settings
  • Focus on Outpatient Prior Auths for surgeries and DME (Durable Medical Equipment)
  • Medicare review experience is highly preferred
  • Experience with reviewing guidelines (this position is more pre-service)
  • Experience with MCG criteria, CareWebQI & Interqual
  • Utilization Management experience required
  • Payer background major plus


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