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Prior Authorization Rn Jobs in Pennsylvania (NOW HIRING)

OSS Health

Authorization Specialist

York, PA · On-site

$17.75 - $23.50/hr

Licensed Practical Nurse (LPN) or certified Medical Assistant (MA) highly preferred. EXPERIENCE/QUALIFICATIONS: • One-year relevant experience in the medical field or in prior authorization ...

OSS Health

Authorization Specialist

York, PA

$17.75 - $23.50/hr

Licensed Practical Nurse (LPN) or certified Medical Assistant (MA) highly preferred. EXPERIENCE/QUALIFICATIONS: • One-year relevant experience in the medical field or in prior authorization ...

OSS Health

Authorization Specialist

York, PA · On-site

$17.75 - $23.50/hr

Licensed Practical Nurse (LPN) or certified Medical Assistant (MA) highly preferred. EXPERIENCE/QUALIFICATIONS: • One-year relevant experience in the medical field or in prior authorization ...

Spectrum Health

Registered Nurse

Philadelphia, PA · On-site

Complete and submit prior authorizations for imaging medication Nexplanon ParaGard and other ... Graduated from an accredited School of Nursing as registered nurse or one year of nursing ...

Excela Health

REGISTERED NURSE RN

Greensburg, PA · On-site

The RN coordinates, directs, and actively participates as an effective member of the ... Obtains prior authorizations and/or assists with indigent programs per physician order based on the ...

Excela Health

REGISTERED NURSE RN

Greensburg, PA · On-site

The RN coordinates, directs, and actively participates as an effective member of the ... Obtains prior authorizations and/or assists with indigent programs per physician order based on the ...

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All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Pennsylvania

Prior Authorization Rn information

See Pennsylvania salary details

$7

$42

$72

How much do prior authorization rn jobs pay per hour?

As of Jul 16, 2026, the average hourly pay for prior authorization rn in Pennsylvania is $42.35, according to ZipRecruiter salary data. Most workers in this role earn between $31.59 and $50.10 per hour, depending on experience, location, and employer.

What do prior authorization nurses do?

Prior authorization nurses review medical documentation and communicate with healthcare providers and insurance companies to obtain approval for specific treatments, medications, or procedures. They ensure that requests meet insurance criteria, often using electronic health records and authorization systems, to facilitate timely patient care.

How to make 150,000 as a nurse?

A Prior Authorization RN can earn $150,000 by gaining extensive experience, obtaining relevant certifications, and working in high-paying settings such as specialty clinics or insurance companies. Advancing to senior or managerial roles, working overtime, or taking on consulting opportunities can also increase earning potential.

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.

How to make $300,000 as a nurse?

A Prior Authorization RN can increase earnings by gaining specialized certifications, working in high-paying healthcare settings, or taking on overtime and extra shifts. Developing expertise in insurance processes and healthcare regulations can also lead to higher-paying roles or consulting opportunities.

How to make an extra 2000 a month as a nurse?

A Prior Authorization RN can increase income by taking on overtime shifts, working in high-demand specialties, or obtaining certifications to qualify for higher-paying roles. Additionally, freelance consulting or remote review work can provide supplementary income outside regular hours.

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
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Prior Authorization Rn jobs near you

Registered Nurse

The Wright Center Medical Group

Scranton, PA • On-site

Full-time

Posted 8 days ago

Job description

Job Type
Full-time
Description
POSITION SUMMARY
The Infectious Disease Specialty Clinic RN works to promote health, prevent disease and assist physicians, and extenders with patient needs by reinforcing physicians' and extenders' instructions. The ID Specialty Clinic RN must honor the Commonwealth of Pennsylvania's guidelines on licensing. The position is responsible for coordination and implementation of PA Department of Health STD Program, the Hepatitis C clinic, infectious disease consults and the HIV/ Ryan White clinic. All communication, including privacy and security of patient protected health information, HIPAA, must be exercised at all times. A multi-disciplinary approach to care is utilized. The RN helps develop and maintain an environment that supports the staff within the Patient-Centered Medical Home.
REPORTING RELATIONSHIPS
This position reports to the collaborating physician and the Program/ Service Line Director.
ESSENTIAL JOB DUTIES AND FUNCTIONS
While living and demonstrating out Core Values, the ID Specialty Clinic RN will:
  • Works with the medical director of Infectious Disease to ensure a high-performing and innovative patient-centered medical home environment.
  • Implements standing orders.
  • Coordinates clinical team activity toward patient-centered care.
  • Demonstrates the ability to respond appropriately to emergencies.
  • Maintains clinical skills by performing the following duties when needed:
  • Uses a variety of standard medical equipment to perform medical procedures or examinations on patients.
    • Performs focused physical assessment through vital signs and interview while assigning them to an exam room when a Medical Assistant is not available.
    • Triages scheduling events based on acuity of signs and symptoms described.
    • Prepares, administers and records medications and treatments as ordered by physicians.
  • Assures all information is captured in electronic medical records.
  • Completes all required or requested patient forms.
  • Provides patient education and health coaching.
  • Triages all patient phone calls and provides consultation in a considerate and respectful manner.
  • Develops long-term plan of care and periodically assesses continuity.
  • Monitors and responds to EMR patient portal communications in a timely manner as needed.
  • Obtains prior authorizations on medications and procedures as needed.
  • Exercises HIPAA confidentiality and security measures at all times during office hours and outside the office.
  • Demonstrates responsibility for self-learning through participation in continuing education activities and conferences.
  • Participates in Total Quality Improvement reviews and activities in the clinical setting.
  • Serves as a clinical resource for staff, learners, patients and families.
  • Performs other duties as directed by Management.

PA DOH STD Program:
  • Counsel patients and obtain consent for testing
  • Create a risk reduction plan for each patient
  • Perform post-test counseling
  • Specimen collection, processing, labeling and packaging; arrange for UPS pick-up
  • Maintain drug inventory and submit required reports and supply orders
  • Submit required monthly logs
  • Read all DOH memos regarding the program, correspondence, statistics, billing and results
  • Reconcile and submit monthly charges
  • Chart inspection for completeness
  • Assist with DOH STD program inspection
  • Submit any required reporting

Hepatitis C:
  • Screen all Hep C consults and referrals
    • Assure appropriate information and documentation is received
  • Assist with submission of medication prior authorization.
  • Send medication prescription to the correct insurance pharmacy
  • Confirm with patient receipt of medication and start date
  • Act as a couch during treatment
  • Order all lab work based on physician protocol and monitor and track results
  • Place reminder calls to non-compliant patients or no-shows
  • Prepare and enter data on the Hep C Care Workflow Sheet

Infectious Disease Consults:
  • Screen all consults
    • Assure appropriate information is received
  • Complete info sheet with attached incoming referral
  • Contact referring physician's office for additional information in needed
  • Send completed referral to ID Physician for review
  • Assist with scheduling patients for appointments

HIV Clinic:
  • Screen all HIV referrals
    • Assure appropriate information and documentation is received
  • HIV teaching and therapy preparation
  • Work with the DOH on referrals and coordination: o Patients out of care
  • Reengaged in care
  • New Diagnosis
  • Send medication prescription to the correct insurance pharmacy
  • Confirm with patient receipt of medication and start date.
  • Act as a couch during treatment
  • Order all lab work based on physician protocol and monitor and track results
  • Place reminder calls to non-compliant patients or no-shows
  • Prepare and update HIV Pink Sheet
  • Updated HIV History tracking

Designated Infection Control Officer:
  • Actively participate in the infection control committee meetings
  • Direct and assist in preparing reports and statistical data for the infection control committee, and quality and safety committee
  • Conduct ongoing review of infection control policies, procedures and guidelines to identify infection control discrepancies and implement revisions as necessary
  • Provide information to the quality and safety committee and department managers to formulate changes in the policies, procedures and/or processes which could reduce the spread of infection
  • Assist in the development and coordination of the infection prevention and control program throughout the health center. Implements the program by formulating, establishing and evaluating policies and procedures relating to patient care infection control measures throughout the health center
  • Perform an annual assessment and develop action plans from the prior year activities.
  • Make recommendations regarding construction, renovation, environmental rounds, and assures compliance with national and/or professional standards
  • Investigate incidents and actively participate in follow up root cause analysis and PDSAs

Requirements
  • BS Degree in Nursing
  • Registered Nurse in the state of Pennsylvania
  • Registered Nurse with 2-4 years' experience in healthcare environment
  • CPR/ACLS certified
  • Knowledgeable of the CDC and OSHA Guidelines
  • Ability to work reliably, with professionalism in a high-volume, high-demand medical practice environment.
  • Proven above average performance as an RN
  • Good organizational and prioritization skills
  • Ability to work independently and with a team
  • Excellent written and oral communication skills
  • Must be a relationship-builder, superior patient advocate, and a self-motivated problem-solver
  • Knowledge of electronic medical records

Apply