ZipRecruiter

Log In

1

Prior Authorization Rn Jobs in North Carolina (NOW HIRING)

CVS Health

Registered Nurse

Winston Salem, NC · On-site

$60K - $129K/yr

Registered Nurse Company: Oak Street Health Role Description: The purpose of a Registered Nurse at ... prior authorizations. * Conduct thorough and accurate reviews of patient medications and update as ...

Sagility LLC

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 ...

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 LLC

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 ...

next page

Showing results 1-20

All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in North Carolina

Prior Authorization Rn information

See North Carolina salary details

$6

$38

$65

How much do prior authorization rn jobs pay per hour?

As of Aug 4, 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 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 popular job titles related to Prior Authorization Rn jobs in North Carolina? For Prior Authorization Rn jobs in North Carolina, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Rn jobs in North Carolina look for? The top searched job categories for Prior Authorization Rn jobs in North Carolina are:
Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in North Carolina as of July 2026, with employment types broken down into 89% Full Time, and 11% Part Time. Highlights an 100% In-person job distribution, with an average salary of $79,854 per year, or $38.4 per hour.

Referral Coordinator/Prior Authorizations

High Country Community Health

Mount Airy, NC

$16 - $18/hr

Other

Posted 5 days ago

Job description

Description

Job Summary and Responsibilities


The referral coordinator is responsible for implementing, monitoring, and tracking of all aspects of the clinic referral processes. Prior authorizations are tasks within the medical field that are required to provide medications, medical equipment, and diagnostic imaging. Responsibilities for both aspects of this position are listed below.


Referral Coordinator duties include:

Coordination and tracking of all clinical referrals utilizing the electronic health record.

Tracking and reporting on all appropriate Patient Centered Medical Home (PCMH) standards as directed. This specifically includes the elements related to tracking referrals, and transition of care.

Work with designated staff on appropriate clinic related referral processes

Collaborate with patient and consulting providers to complete referral process

Provides the highest level of customer service to internal and external clients.

Other duties as assigned

Prior Authorization duties include:

Responsible for all aspects of the prior authorization process

Collecting all the necessary documentation

Contacting the patient for additional information to ensure completion of the required prior authorization for the prescribed medication, medical equipment and diagnostic imaging

Interacts with patients, and insurance companies as necessary, to request prior authorizations.

Provides the highest level of customer service to internal and external clients.

Other duties as assigned

Requirements

Requirements/Qualifications/Skills/Experience

Minimum of at least 2 years in primary medical care setting. At least 1 year of experience with referrals preferred. Medical certification or licensure such as CMA, LPN, or RN preferred. Proficiency with electronic health records.

Apply