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Prior Authorization Rn Jobs in Massachusetts (NOW HIRING)

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 ...

Valley Health Systems

Registered Nurse

Holyoke, MA · On-site

$34.33 - $53.81/hr

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

Valley Health Systems

Registered Nurse

Holyoke, MA · On-site

$34.33 - $53.81/hr

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

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)

Allston, MA

$90K/yr

The RN is supervised by the Care Team Leader and will learn about working on a community-based ... Obtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary ...

Vinfen

Clinical Care Manager (RN)

Hyannis, MA

$90K/yr

The RN is supervised by the Care Team Leader and will learn about working on a community-based ... Obtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary ...

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All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Massachusetts

Prior Authorization Rn information

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$8

$46

$78

How much do prior authorization rn jobs pay per hour?

As of Sep 14, 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.

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 Massachusetts as of September 2026, with employment types broken down into 1% As Needed, 79% Full Time, 15% Part Time, 1% Temporary, and 4% Contract. Highlights an 88% Physical, 1% Hybrid, and 11% Remote job distribution, with an average salary of $95,962 per year, or $46.1 per hour.

Nurse- RN

New Bedford, MA • On-site

GREATER NEW BEDFORD COMMUNITY HEALTH CENTER
Health Care and Social Assistance • 201 - 500 employees
Learn more about GREATER NEW BEDFORD COMMUNITY HEALTH CENTERexternal

$34.69 - $48.25/hr

Other

Posted 10 days ago

Job description

Four 10 Hour shifts: Monday, Tuesday, Thursday and Friday schedule.
POSITION SUMMARY:
As a critical member of the patient care team, Registered Nurses (RN) are responsible for providing age appropriate care to patients in his/her practice setting.
ESSENTIAL FUNCTIONS:
Reasonable accommodations may be made to enable individuals with disabilities to perform the following essential functions:
  1. Conducts patient visits based on department needs and scope of practice. Obtains a nursing history utilizing the patient, family, medical record, professional staff, community agencies and other departments. Interview patients and families to gain ideas, feelings, and facts that help identify their needs and goals. Observe overt and covert signs and symptoms in a systematic way. Identify and record physical, social and psychosocial needs of the patient and family. Develop nursing assessment based on data collection.
  2. Responds appropriately to patient codes and other needs for emergency patient care and related situations. Implement appropriate intervention based on an ongoing assessment of patients.
  3. Assists the provider in developing measurable short and long term goals which are patient centered and derived from the medical diagnosis. Involve the patient and family in goal setting and individual plan of care.
  4. Manages patient or other external requests for Visiting Nurse referrals, medication prior authorization and hospital follow-up requests that the call center staff is unable to schedule in an appropriate time frame.
  5. Serves as patient advocate. Defend and preserve the rights of patients pertaining to all aspects of their care, knowledge and privacy.
  6. Contributes to orientation of new nursing personnel. Responds appropriately to facility acuity and activity by providing assistance to peers, patients, and staff as needed.
  7. Assignment may include the monitoring/ordering of immunizations/stock medications and confirming expiration dates on a consistent basis. Expired immunizations/stock medications will be disposed of as directed by facility procedures.
  8. Documents all ordered test in the Electronic health record and prepares test results for review by the provider. Notifies the patients of test results as directed by the provider. Provides any other follow through as directed by the provider and documents patient interaction in the electronic health record. Provides necessary documentation of patient encounter forms.
  9. Assists the provider with procedures as directed.
  10. Processes medication refills based on facility protocol.

REQUIRED KNOWLEDGE & SKILLS:
  1. Demonstrates knowledge of the principles of growth and development over the life span and possess the ability to assess data relative to the patient's status.
  2. Ability to interpret the appropriate information needed to identify each patient's requirement relative to his/her specific age.
  3. Ability to provide the care needed as described in the patient policies and procedures.
  4. Effectively uses Electronic Medical Records.
  5. Demonstrates flexibility when responding to change. Assumes accountability for all actions.

REQUIRED EDUCATION & OTHER CREDENTIALS:
  1. Registered Nurse with current Massachusetts license; Associates or equivalent,in Nursing required. Bachelor in Nursing preferred.
  2. 1-2 years' experience in community health and/or triage nursing preferred.
  3. CPR certification (with AED) required. Responsible for keeping certification current. ACLS or PALS preferred.
  4. IV experience preferred.
  5. Bilingual preferred.

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