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Prior Authorization Rn Jobs in California (NOW HIRING)

Care Navigators On Demand

$39 - $45/hr

Prior Authorization RN Case Manager Granada Hills, CA Full-Time Direct Hire Description Therole of the Prior Authorization Nurse Case Manager (PACM) is to promotethe quality and cost effectiveness of ...

Aquent

Prior Authorization Specialist

Palo Alto, CA · On-site

$35.81 - $38.96/hr

Be authorized to work in the United States * Not require sponsorship of any kind for the duration ... Certified or Registered Pharmacy Technician (CPhT) credential or prior pharmacy experience.

Regal Medical Group, Inc.

Position Summary: The role of the Director, Prior Authorization is to oversee the prior ... RN license.

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How much do prior authorization rn jobs pay per hour?

As of Jun 8, 2026, the average hourly pay for prior authorization rn in California is $41.69, according to ZipRecruiter salary data. Most workers in this role earn between $31.06 and $49.33 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.
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Prior Authorization Rn jobs near you
Prior Authorization RN

Prior Authorization RN

Healthcare Support Staffing

Long Beach, CA • On-site

Other

Posted 15 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!


Interested in being considered? 

IF IS JOB OPPORTUNITY IS FOR YOU, GIVE ME A CALL AT 321-574-6926 


Job Description

More Insight of Daily Responsibilities:

Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care 

Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.

Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.

Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care. 


Qualifications

Hospital Utilization Management.

Insurance Utilization Manager/Review. No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past hospital experience (3-4 years of experience, less experience is ok if they have more Utilization Review experience) 


Additional Information

Hello!

My name is Krishna Gapuz and I am a Recruiting Consultant with Healthcare Support. I specialize in the placement of medical professionals nationwide (both clinical and non-clinical). We just had an amazing opportunity become available for a Utilization Review RN right in Syracuse, NY (Zip Code 13202). They are looking to start a qualified candidate as quickly as possible (pending hire requirements). This is an amazing opportunity for a Monday - Friday 8:00a.m.-6:00p.m. job with a stable, prestigious company (This Company is one of the leading providers of Healthcare in your area!) 

If you would like to be considered for this opportunity please respond to this Email as soon (today) as possible! (or you're more than welcome to call me at my office 321-574-6926.   

If you opt to respond to this Email, please include:

  1. Why did you leave your last position and how long ago (or why are you looking to leave your current position)?
  2. How much were you last making (hourly)?
  3. If offered, how soon could you start?


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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