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Prior Authorization Rn Jobs in North Carolina (NOW HIRING)

IVX Health

Infusion Registered Nurse (RN)

Cary, NC · On-site

As a Registered Nurse at IVX Health, you'll be at the forefront of delivering personalized ... Support Operations and Training - Assist in inventory management, prior authorizations, and ...

IVX Health

Infusion Registered Nurse (RN)

Durham, NC · On-site

Support Operations and Training - Assist in inventory management, prior authorizations, and ... Active and Unrestricted Registered Nurse (RN) license * Life Support Certifications - BLS ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Job title: RN Utilization Management Reviewer We are currently hiring a talented RN, Utilization ... Conducts timely clinical decision review for services requiring prior authorization in a variety of ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Job title: RN Utilization Management Reviewer We are currently hiring a talented RN, Utilization ... Conducts timely clinical decision review for services requiring prior authorization in a variety of ...

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All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in North Carolina

Prior Authorization Rn information

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$38

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How much do prior authorization rn jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for prior authorization rn in North Carolina is $38.39, according to ZipRecruiter salary data. Most workers in this role earn between $28.61 and $45.43 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 North Carolina as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $79,854 per year, or $38.4 per hour.

Experienced Prior Authorizations Specialist - Pain Management

Envision Pain Management

Boone, NC • On-site

$17 - $24/hr

Full-time

Re-posted 21 days ago

Job description

About Us

At Envision Pain Management, we provide a comprehensive, patient-centered approach to pain management—combining advanced procedures, therapies, and diagnostics to help patients get back to living their lives. Our team of specialists focuses on minimally invasive treatments, personalized care plans, and compassionate support for patients dealing with chronic pain.

Job Summary

We are seeking a detail-oriented Prior Authorization Specialist to join our growing team in western North Carolina. This role is critical in ensuring patients receive timely care by securing insurance authorizations for procedures, diagnostic testing, and treatment plans.

If you thrive in a fast-paced medical environment and understand the importance of accuracy and urgency, this is a great opportunity to directly impact patient care.

Typical Duties

  • Verify patient insurance benefits, eligibility, coverage details and clinical information to ensure that all reimbursement requirements are met.
  • Obtain prior authorizations for procedures, injections, imaging, and therapies
  • Notifies the necessary parties within the required timeframe for routine and urgent requests for services.
  • Communicates with patients and/or referring physicians on non-covered benefits or procedure coverage issues.
  • Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
  • Ensures insurance carrier documentation requirements are met and authorization documentation is entered and recorded in the patient's records.
  • Appeals pre-authorization denials and/or set-up peer to peer reviews.
  • Stay up-to-date with insurance policies, payer requirements, and industry regulations impacting prior authorizations
  • Collaborate with billing, clinical, and patient services teams to ensure seamless coordination of care and reimbursement
  • Monitor authorization trends and provide reports to management to support workflow improvements
  • Builds and maintains working relationships with staff, referral sources, insurance companies, and medical providers.
  • All other duties as requested

Minimum Qualifications

  • High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration, Nursing, or related field preferred
  • 2+ years of experience in medical prior authorizations (pain management, orthopedics, or specialty care preferred)
  • Strong knowledge of insurance plans, CPT/ICD-10 coding, and medical terminology
  • Experience working with procedures such as injections, imaging, or specialty treatments preferred
  • Experience using electronic medical records systems (Athena)

Knowledge, Skills, Abilities and Other Characteristics

  • Proficiency with Microsoft applications and internet-based programs
  • Strong interpersonal skills with the ability to establish strong working relationships
  • Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
  • Strong time management skills to prioritize assignments and meet the designated deadline. Ability to anticipate, recognize, and meet the needs of the patients and their families
  • Ability to work in a team-based environment to accomplish goals and objectives
  • Ability to critically think, problem solve and make independent decisions supporting the authorization process, including interactions with payer representatives, physicians, and hospital case managers
  • Ability to act with integrity, professionalism, and confidentiality adhering to all HIPAA standards

Why Join Us

  • Work with a collaborative, patient-focused care team
  • Be part of a growing specialty practice with multiple North Carolina locations
  • Opportunity to make a meaningful impact on patient access to care
  • Competitive benefits package; pay dependent upon experience

Company Description

Envision Pain Management uses a comprehensive approach to pain and spine care. Our physicians are board-certified and fellowship-trained in interventional pain medicine.