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Prior Authorization Rn Jobs in Michigan (NOW HIRING)

Michigan Healthcare Professionals, P.C.

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Registered Nurse - Oncology

Troy, MI · On-site

... Obtain prior authorizations from insurance companies · Arrange for hospital admissions and ... - RN · Obtains ONC certification within 24 months of hire · Sound clinical experience and ...

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Prior Authorization Rn information

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$36

$62

How much do prior authorization rn jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for prior authorization rn in Michigan is $36.82, according to ZipRecruiter salary data. Most workers in this role earn between $27.45 and $43.56 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 Michigan as of September 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, 1% Temporary, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $76,585 per year, or $36.8 per hour.

MICHIGAN Registered Nurse REMOTE - Patient Assessment

Wixom, MI • On-site

J&B Medical Supply Co Inc
Outpatient Health Care • 201 - 500 employees
Learn more about J&B Medical Supply Co Incexternal

$35/hr

Full-time

PTO

Re-posted 9 days ago

Job description

Description:

REMOTE  - MUST HAVE VALID MICHIGAN RN LICENSE Our Nursing Team is growing! Great Benefits after 30 days! PTO & Holiday Pay after 90!


Summary: Our Staff Nurse's are responsible for conducting patient assessments by phone (ours) to determine individual needs for incontinence supplies.


ARE YOU READY TO MAKE A MOVE? APPLY NOW! NEW HIRE ORIENTATION STARTS SEPTEMBER 9TH

***** EQUIPMENT IS NOT PROVIDED FOR REMOTE STAFF, YOU MUST HAVE YOUR OWN COMPUTER.


Essential Functions

  • Consults by phone with client, primary caregiver, primary care physician or specialist, case managers and other community resources to determine if client qualifies for a particular program.
  • Expectation is that Nurse will complete 20-25 assessments daily, on average with 98% accuracy.
  • Conducts clinical assessments by phone and documents the client’s medical history. Monitors success rates. All products ordered must be assessed for use and quantity needs per day.
  • Identifies appropriate product and quantity needs based on assessment. If formulary product will not meet needs, then reviews needs and potential solutions with Nurse Manager.
  • Reassesses if there is a change in a client’s medical condition or an increase in quantity request.
  • Obtains prior authorization from the state contract administrator for off-formulary or over-quantity requests.
  • Reviews letters of medical necessity to determine if client qualifies for product or quantity requested.
  • Reviews accounts for accuracy, reporting any errors to the appropriate department manager/leader.
  • Participates in after-hours emergency call rotation.
  • Understanding of insurance guidelines.
  • Utilize intranet tools to complete assessments.
  • Provides education to other J & B employees or external clients regarding products.


Position Type

This is a full time REMOTE or in office position 40 hours per week. Monday through Friday, hours of work vary between 8:00am to 6:00pm. Occasional early mornings, evening and weekend work may be required as job duties demand.

Requirements:
  • Current Registered Nursing License (RN) with the State of Michigan (MI ONLY - CNL'S ARE NOT ACCEPTED)
  • 2+ years previous work experience demonstrating patience, compassion and strong communication skills
  • Must be great on the computer, able to use multiple databases simultaneously

Preferred Education and Experience

  • 3 years of nursing experience
  • Knowledge of medical terminology
  • Medicare and Medicaid background
  • Durable Medical Equipment (DME)

Other Duties

All other duties as assigned by management. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are request of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.