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Prior Authorization Rn Jobs in California (NOW HIRING)

Talencia

RN - Case Manager

San Pedro, CA · On-site

$68 - $72/hr

Registered Nurse - Case Manager Location: San Pedro, CA Schedule: 08:00 - 16:30 (5x8; Self ... Arrange necessary resources and equipment (DME), complete prior authorizations, and initiate post ...

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Prior Authorization Rn information

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How much do prior authorization rn jobs pay per hour?

As of Aug 15, 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
Infographic showing various Prior Authorization Rn job openings in California as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $86,717 per year, or $41.7 per hour.

Care Review Clinician (RN)

Molina Healthcare

San Francisco, CA • On-site

Other

Medical

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

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

164th of 308 rated insurance

Job description

Job Title

Clinical Member Services Reviewer

Job Description

Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

  • Assess services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
  • Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
  • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
  • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
  • Processes requests within required timelines.
  • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
  • Requests additional information from members or providers as needed.
  • Makes appropriate referrals to other clinical programs.
  • Collaborates with multidisciplinary teams to promote the Molina care model.
  • Adheres to utilization management (UM) policies and procedures.

Required Qualifications

  • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
  • Registered Nurse (RN). License must be active and unrestricted in state of practice.
  • Ability to prioritize and manage multiple deadlines.
  • Excellent organizational, problem-solving and critical-thinking skills.
  • Strong written and verbal communication skills.
  • Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

  • Certified Professional in Healthcare Management (CPHM).
  • Recent hospital experience in an intensive care unit (ICU) or emergency room.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

What Molina Healthcare employees say

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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