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Prior Authorization Rn Jobs in California (NOW HIRING)

Molina Healthcare

Care Review Clinician (RN)

Long Beach, CA · Remote

$26.41 - $51.49/hr

The ideal candidate will have experience with UM and prior authorization with both inpatient and ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ...

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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

Registered Nurse (RN) - Outpatient Neurology Clinic - RNON26-06390

NavitasPartners

Eureka, CA • On-site

$50/hr

Other

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

Job description

Job Title: Registered Nurse (RN) - Outpatient Neurology Clinic

Location: Eureka, CA

Position Overview:

"Navitas Healthcare, LLC" is seeking a Registered Nurse (RN) for an Outpatient Neurology Clinic. This role focuses on patient care coordination, infusion management, medication refills, prior authorizations, patient education, and communication with patients and providers in a fast-paced outpatient setting.

Key Responsibilities:

  • Provide nursing care and support within an outpatient neurology clinic

  • Process infusion orders and coordinate infusion-related care

  • Manage prescription refills and medication requests

  • Complete prior authorizations and coordinate insurance approvals

  • Respond to patient calls, MyChart messages, and clinical inquiries

  • Assist with patient assessments and office visits

  • Support neurological evaluations and cognitive screening processes

  • Educate patients and families regarding treatment plans and follow-up care

  • Maintain accurate patient documentation in EPIC EMR

  • Collaborate with physicians and interdisciplinary healthcare teams

Required Qualifications:

  • Active California RN License

  • Minimum 1 year of RN experience

  • Strong communication and patient care coordination skills

  • Ability to work independently in an outpatient setting

  • Experience with electronic medical records

Preferred Qualifications:

  • EPIC experience

  • Neurology clinic experience

  • Infusion nursing experience

  • Experience handling medication refills, prior authorizations, and patient triage

Work Environment:

  • Outpatient Neurology Clinic

  • No weekends

  • No on-call requirements

  • No floating required

  • Team-based outpatient practice environment

For more details reach at sthakur@navitashealth.com

About Navitas Healthcare, LLC: It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

Apply