ZipRecruiter

Log In

1

Prior Authorization Rn Jobs in Massachusetts (NOW HIRING)

Vinfen

Clinical Care Manager (RN)

Hyannis, MA

$90K/yr

The RN will act as a Clinical Care Manager and is a vital member of the Community Partner Care Team ... Obtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary ...

Vinfen

Clinical Care Manager (RN)

Allston, MA

$90K/yr

The RN will act as a Clinical Care Manager and is a vital member of the Community Partner Care Team ... Obtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary ...

Valley Health Systems

Registered Nurse

Holyoke, MA · On-site

$34.33 - $53.81/hr

... prior authorizations, prescription refills, and adherence to clinical protocols Qualifications ... Current license as a Registered Nurse within the Commonwealth of Massachusetts; current CPR ...

Vinfen

Clinical Care Manager (RN)

Somerville, MA

$90K/yr

The RN will act as a Clinical Care Manager and is a vital member of the Community Partner Care Team ... Obtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary ...

Exaways Corporation

Pharmacy Patient Liaison

Boston, MA · On-site

$19 - $23/hr

... prior authorization submission 2) Successful team members are self-motivated and excel in time ... staff (CNAs, MDs, RNs) 4) Capacity to work independently by managing workload and meeting ...

Fenway Health

LPN

Boston, MA · On-site

$28.21 - $31.13/hr

Provides nursing support to RNs, LPNs and MAs * Places and Maintains IV Lines * Administers ... Works with MA and pharmacy to call in prescription refills or obtain prior authorizations * Assists ...

FENWAY HEALTH

LPN

Boston, MA

$28.21 - $31.13/hr

Provides nursing support to RNs, LPNs and MAs * Places and Maintains IV Lines * Administers ... Works with MA and pharmacy to call in prescription refills or obtain prior authorizations * Assists ...

Fenway Health

LPN

Boston, MA · On-site

$28.21 - $31.13/hr

Provides nursing support to RNs, LPNs and MAs * Places and Maintains IV Lines * Administers ... Works with MA and pharmacy to call in prescription refills or obtain prior authorizations * Assists ...

FENWAY HEALTH

LPN, Part-Time

Boston, MA

$28.21 - $31.13/hr

Provides nursing support to RNs, LPNs and MAs * Places and Maintains IV Lines * Administers ... Works with MA and pharmacy to call in prescription refills or obtain prior authorizations * Assists ...

Fenway Health

LPN, Part-Time

Boston, MA · On-site

$28.21 - $31.13/hr

Provides nursing support to RNs, LPNs and MAs * Places and Maintains IV Lines * Administers ... Works with MA and pharmacy to call in prescription refills or obtain prior authorizations * Assists ...

Fenway Health

LPN, Part-Time

Boston, MA · On-site

$28.21 - $31.13/hr

Provides nursing support to RNs, LPNs and MAs * Places and Maintains IV Lines * Administers ... Works with MA and pharmacy to call in prescription refills or obtain prior authorizations * Assists ...

Excel Nursing Services

Registered Nurse (RN)

Athol, MA

$32 - $100/hr

Prior RN experience in homecare or clinical settings * Strong interpersonal and patient care skills * Current drivers license * CPR/First Aid certified Ready to make a difference as a Registered ...

next page

Showing results 1-20

All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Massachusetts

Prior Authorization Rn information

See Massachusetts salary details

$8

$46

$78

How much do prior authorization rn jobs pay per hour?

As of Jun 24, 2026, the average hourly pay for prior authorization rn in Massachusetts is $46.14, according to ZipRecruiter salary data. Most workers in this role earn between $34.38 and $54.62 per hour, depending on experience, location, and employer.

How to make $300,000 a year as a nurse?

A Prior Authorization RN can earn $300,000 annually by gaining extensive experience, obtaining advanced certifications, and working in high-paying settings such as specialty clinics or insurance companies. Increasing workload, taking on leadership roles, or working overtime can also boost income, but reaching this level typically requires a combination of expertise, efficiency, and strategic employment choices.

How to make 150,000 as a nurse?

A Prior Authorization RN can earn $150,000 by gaining extensive experience, obtaining relevant certifications, and working in high-paying settings such as specialty clinics or insurance companies. Advancing to senior or managerial roles, working overtime, or taking on consulting opportunities can also increase earning potential.

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.

Can nurses do prior authorizations?

Prior authorization nurses, often called utilization review nurses or case managers, are qualified to handle prior authorization requests. They review medical documentation, communicate with providers and insurance companies, and ensure compliance with payer requirements, often using electronic health record systems. Certification in case management or utilization review can enhance their ability to perform these tasks effectively.

How to make an extra 2000 a month as a nurse?

A Prior Authorization RN can increase income by taking on additional shifts, working overtime, or offering consulting services to healthcare providers. Developing specialized knowledge in insurance authorization processes and obtaining relevant certifications can also lead to higher-paying opportunities or freelance work outside regular hours.

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 the most commonly searched types of Prior Authorization Rn jobs in Massachusetts? The most popular types of Prior Authorization Rn jobs in Massachusetts are:
What are popular job titles related to Prior Authorization Rn jobs in Massachusetts? For Prior Authorization Rn jobs in Massachusetts, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Rn jobs in Massachusetts look for? The top searched job categories for Prior Authorization Rn jobs in Massachusetts are:
What cities in Massachusetts are hiring for Prior Authorization Rn jobs? Cities in Massachusetts with the most Prior Authorization Rn job openings:
Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in Massachusetts as of June 2026, with employment types broken down into 70% Full Time, 26% Part Time, and 4% Summer. Highlights an 100% In-person job distribution, with an average salary of $95,962 per year, or $46.1 per hour.
Clinical Care Manager (RN)

Clinical Care Manager (RN)

Vinfen

Hyannis, MA

$90K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 25 days ago

Vinfen rating

8.6

Company rating: 8.6 out of 10

Based on 11 frontline employees who took The Breakroom Quiz

Job description

Schedule:Mon-Fri 9:00am-5:00pm
Salary:$90,000 / year
The Clinical Care Manager - Registered Nurse (RN) on the Community Partner team provides clinical care management and intensive care coordination for people with complex medical and behavioral health needs. The RN will act as a Clinical Care Manager and is a vital member of the Community Partner Care Team which includes licensed behavioral health clinicians, a care transitions manager, community health workers and a team administrator. The RN is supervised by the Care Team Leader and will learn about working on a community-based interdisciplinary team, trauma/recovery skills, care transitions support, behavioral health and substance use disorder services, and person-centered care planning. The RN must be willing to visit enrollees in their homes throughout the service area as well as work from our office.
The Clinical Care Manager - Registered Nurse will also:
  • Conduct comprehensive assessment of enrollees including the medical, psychiatric and social components.
  • Review/sign off on medical component of comprehensive assessment
  • Monitor enrollee's health status and needs and provide nursing and medical care coordination, including revising health related treatment goals and plans in collaboration with the enrollee and the Care Team.
  • Coordinate the development, implementation, and ongoing review of the care plan.
  • Conduct medication reviews and reconciliation including adjustment by protocol.
  • Communicate and collaborate with ACO teams and serve as a team resource.
  • Follow up of an enrollee's inpatient stay, (including hospital, shelter, substance abuse programs, SNF), and collaborate with enrollee, Care Team, and hospital staff to coordinate transitions of care.
  • Collaborate and communicate with the enrollee's other medical, behavioral health and home-based providers regarding changes in services, hospitalizations, and other care needs and goals
  • Obtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary services.
  • Perform other related duties, as assigned.
Why Vinfen? We are committed to you! We offer great training, great benefits, career growth and job security!
Our comprehensive and generous benefits package includes:
  • A fully funded, employer-sponsored retirement plan that requires no employee contribution as well as an employee-funded 403(b) plan
  • First-rate Medical, Dental and Vision plans that are open to all employees scheduled to work 30 hours per week or more. Plus, we offer a generous employer contribution toward the cost of medical insurance!
  • Employer-paid Life, Accidental Death & Dismemberment and Long-Term Disability Insurance
  • Employer-paid Short-Term Disability Insurance along with the option to purchase additional, voluntary, Short-Term disability insurance
  • Flexible Spending Accounts (Health and Dependent care)
  • Voluntary Term, Whole Life, Accident and Critical Care Insurance
  • Generous paid time off (Employees scheduled to work 20 hours or more per week):
    • 15 days of Vacation per year
    • 12 Paid Holidays
    • 10 Sick Days per year
    • 3 Personal days per year
    • Educational Assistance and Tuition Remission Programs
    • $500 Employee Referral Bonus with no annual cap!
    • Other generous benefits including discounted YMCA memberships, access to discounted movie tickets and more

About Us

Established in 1977, Vinfen is a nonprofit, health and human services organization and a leading provider of community-based services to individuals with mental health conditions, intellectual and developmental disabilities, brain injuries, and behavioral health challenges. Our services and advocacy promote the recovery, resiliency, habilitation, and self-determination of the people we serve. Vinfen's 3,200 dedicated employees are experienced, highly-trained professionals who provide a full range of supportive living, health, educational, and clinical services in 318 programs throughout Massachusetts and Connecticut. For more information about Vinfen, please visit www.vinfen.org/careers


My Job. My Community. My Vinfen.
Vinfen is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.
Keywords: RN jobs, Registered Nurse, Clinical Care Management, ACO, Medicaid, Care Team, Community Partners, Care Manager, VinfenIC, VinfenRN,RN, Registered Nurse, Nursing

What Vinfen employees say

Pay

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply