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Prior Authorization Rn Jobs in New York (NOW HIRING)

Claim Health

Prior Authorization Specialist

New York, NY · On-site

$19.75 - $26.25/hr

Prior authorization is one of the largest operational bottlenecks for agencies. Our platform ... Comfortable working independently in a fast-moving startup Nice to Have * RN, LPN, or clinical ...

Guided Care

Prior Authorization Case Manager

Brooklyn, NY · On-site

$55K - $65K/yr

Prior Authorization Case Manager The Prior Authorization Case Manager obtains prior authorizations ... Skilled nursing admissions or business office experience preferred. * Independent and self ...

Longevity Health Plan

RN Field Coordinator

Bronx, NY · On-site

$100K - $123K/yr

The RN Field Coordinator is instrumental in supporting Longevity Health's Institutional Special ... Support transitions of care, assist with prior authorization requests, and help members access ...

Adecco

Registered Nurse

Thornwood, NY · On-site

$45 - $47/hr

... prior authorization · Provide patient education · Documenting care in the EMR while ensuring high quality patient care. Requirements Include: · New York RN licensure · Minimum of one year of ...

Project Renewal

Registered Nurse

New York, NY · On-site

$98K - $100K/yr

Registered Nurse Location: 59th Street Shelter Salary: 98k-100k Shift: Monday- Friday, 8:00am-4 ... prior authorization for medications or medical supplies * Assisting with medication refills and ...

projectrenewal

Registered Nurse

New York, NY

$36.40/hr

Registered Nurse Location: Clinton Residence Schedule: 28 hours per week Hourly Rate: $36.40 ... prior authorization for medications or medical supplies * Assisting with medication refills and ...

Project Renewal

Registered Nurse

New York, NY · On-site

$36.40/hr

Registered Nurse Location: Clinton Residence Schedule: 28 hours per week Hourly Rate: $36.40 ... prior authorization for medications or medical supplies * Assisting with medication refills and ...

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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 4, 2026, the average hourly pay for prior authorization rn in New York is $46.22, according to ZipRecruiter salary data. Most workers in this role earn between $34.47 and $54.71 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.
More about Prior Authorization Rn jobs
What are the most commonly searched types of Prior Authorization Rn jobs in New York? The most popular types of Prior Authorization Rn jobs in New York are:
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Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in New York as of July 2026, with employment types broken down into 100% Full Time. Highlights an 49% In-person, 13% Hybrid, and 38% Remote job distribution, with an average salary of $96,130 per year, or $46.2 per hour.

Nurse Case Manager, Prior Authorization RN

HealthCare Partners, MSO

Garden City, NY • On-site

Full-time

Medical, Dental, Retirement, PTO

Re-posted 4 days ago

Job description

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.
HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care.  Interested in joining our successful Garden City Team?  We are currently seeking a Nurse Case Manager, Prior Authorization RN!  
Position Summary: The Nurse Case Manager, Prior Authorization RN is responsible for reviewing and processing prior authorization requests for medical services, ensuring that all clinical criteria and health plan requirements are met. This role reports to the Manager of Inpatient Utilization Management and involves collaborating with healthcare providers, patients, and internal teams to determine the medical necessity of requested services, ensuring compliance with insurance guidelines, and maintaining accurate documentation. The Nurse Case Manager, Prior Authorization RN will support the goal of delivering timely and efficient authorization decisions while promoting quality patient care.
Essential Position Functions/Responsibilities:
  • Review incoming prior authorization requests for medical services, including procedures, medications, and diagnostic tests, ensuring that they meet clinical guidelines and health plan requirements.
  • Evaluate medical records, clinical documentation, and provider notes to determine the medical necessity and appropriateness of requested services based on established criteria.
  • Communicate with healthcare providers, including physicians and specialists, to obtain additional information or clarification needed to process prior authorization requests.
  • Work closely with other teams, such as utilization management, care management, and pharmacy, to ensure accurate and timely processing of prior authorization requests.
  • Ensure all prior authorization processes comply with relevant healthcare regulations, health plan policies, and turnaround time standards.
  • Accurately document the review process, decisions, rationale, and outcomes of prior authorization requests, maintaining clear and comprehensive records in the system.
  • Support the review and resolution of denied prior authorization requests, including assisting with the preparation of information for appeals, when necessary.
  • Educate healthcare providers and patients on the prior authorization process, required documentation, and health plan requirements.
  • Assist in identifying opportunities for process improvements in the prior authorization workflow to increase efficiency and reduce errors.
  • Ensure that prior authorization requests are processed within designated time frames to meet regulatory and health plan requirements.

Qualification Requirements:
Skills/Knowledge/Abilities
  • Strong understanding of clinical procedures, diagnoses, and treatments, with the ability to assess medical necessity based on evidence-based guidelines (MCG, National Coverage Determinations and Local Coverage Determinations).
  • Excellent written and verbal communication skills, particularly in interacting with healthcare providers and patients in a professional and clear manner.
  • Ability to manage multiple requests simultaneously while maintaining a high level of accuracy and efficiency.
  • Strong critical thinking and decision-making skills to evaluate requests and address issues related to medical necessity and health plan compliance.
  • Understanding of the prior authorization process, including guidelines, clinical review criteria, regulatory requirements and turnaround time expectations.
  • Ability to adapt to changing health plan requirements, clinical criteria, and workflow processes.

Training/Education:
  • Registered Nurse (RN) with an active and unrestricted nursing license in the state of practice required; Bachelor’s degree in Nursing (preferred).

Experience:
  • At least 2-3 years of clinical nursing experience, with at least 1 year in utilization management, prior authorization, or a related healthcare setting.
  • Experience in reviewing medical records, clinical documentation, and prior authorization requests.
  • Familiarity with clinical decision-making criteria and evidence-based guidelines used in the prior authorization process (preferred).

Our website: HealthCare Partners
Base Compensation: $90,000 – 105,000 annually
Bonus Incentive: Eligibility based off organizational performance
Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)
Equal Employment Opportunity Statement:
HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.
 

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