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Prior Authorization Rn Jobs in Rhode Island (NOW HIRING)

Lancesoft

Licensed Vocational Nurse-LPN

Woonsocket, RI · On-site +1

$26 - $28.50/hr

We are seeking experienced LPN/LVN candidates with prior authorization experience in a specialty medical office (MDO), PBM, or clinical setting. * This role requires the ability to work in a high ...

Medix

Registered Nurse - Family Medicine

Providence, RI · On-site

$37.50 - $45/hr

Support care management initiatives and assist with referrals, prior authorizations, and medication ... Active Registered Nurse (RN) license in Rhode Island * Minimum 1 year of RN experience in Family ...

Medix

Registered Nurse - Internal Medicine

Providence, RI · On-site

$37.50 - $45/hr

... prior authorizations, and care coordination. * Document patient encounters, assessments, education ... Qualifications * Active Registered Nurse (RN) license in Rhode Island. * Minimum 1 year of RN ...

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All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Rhode Island

Prior Authorization Rn information

See Rhode Island salary details

$7

$41

$70

How much do prior authorization rn jobs pay per hour?

As of Jul 23, 2026, the average hourly pay for prior authorization rn in Rhode Island is $41.37, according to ZipRecruiter salary data. Most workers in this role earn between $30.82 and $48.94 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
What are popular job titles related to Prior Authorization Rn jobs in Rhode Island? For Prior Authorization Rn jobs in Rhode Island, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Rn jobs in Rhode Island look for? The top searched job categories for Prior Authorization Rn jobs in Rhode Island are:
Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in Rhode Island as of July 2026, with employment types broken down into 72% Full Time, 22% Part Time, and 6% Contract. Highlights an 100% In-person job distribution, with an average salary of $86,050 per year, or $41.4 per hour.
Referral & Authorization Spec

Referral & Authorization Spec

Care New England Health System

Warwick, RI • On-site

Full-time

Posted 11 days ago

Care New England Health System rating

7.2

Company rating: 7.2 out of 10

Based on 31 frontline employees who took The Breakroom Quiz

334th of 889 rated healthcare providers

Job description

Job Summary
The Referral and Authorization Specialist plays a vital and strategic role in supporting the financial health of the organization by overseeing the referral and authorizations processes for specialty visits and outpatient testing. This position is essential in centralizing and streamlining the authorization workflow, which is integral to the success of the organization's operations, patient experience, and financial performance. Obtaining timely and accurate authorization information, prior to performing services, reduces claim denials, ensures payer compliance, and establishes better organizational financial outcomes. This position is crucial to the organization's financial success and the delivery of a positive provider and patient experience, as their timely and accurate processing of referrals and authorizations ensures that patients receive the necessary care without delays, while also optimizing reimbursement.
Duties & Responsibilities
  • Request and obtain insurance referral and prior authorizations via the insurance carrier and/or third-party authorization companies and then track the status within CNE's EHR.
  • Evaluate payer policies to understand authorization and notice of admission policies.
  • Communicate the request/status of the insurance referral and/or prior authorization with internal referring provider offices/departments via the EHR.
  • Utilize CNE's EHR to document all work related to obtaining and/or verifying insurance referral and prior authorizations.
  • Work with both internal and external referring provider offices/departments to obtain the necessary information to obtain and/or verify the approval of the insurance referral or prior authorization.
  • Verify the accuracy of the patient's insurance information to obtain the insurance referral or prior authorization.
  • Communicate via the EHR any issues related to processing the referral (i.e., PCP not updated with the payer, provider documentation not complete) and/or the accuracy of the patient's insurance information to the referring department.
  • Communicate any issues related to obtaining and/or verifying the approval of the insurance referral and/or prior authorization to management.
  • Manage the start of the external referral process for all CNEMG PCPs, to include submitting referrals, obtaining an approved insurance authorization, and sending all relevant clinical documentation to the external provider.
  • Explain the Notice of Non-Covered Service Waiver and Notice of Non-Approved Prior Authorization waiver to patients.
  • Work and monitor EHR WQ's and in Basket pools through the workday.
  • Performs other duties as assigned.

Requirements
  • High School or GED is required. Associate degree or Certified/Registered Medical Assistance preferred. 5-7 years of experience working in healthcare. 3 years of experience processing insurance referral and/or prior authorizations. Bilingual preferred.
  • Ability to communicate with people of various diverse backgrounds in a sensitive and compassionate way.
  • Knowledge of federal regulations related to the No Surprises Act and healthcare billing compliance.
  • Must have excellent presentation, communication, organizational and customer service skills.
  • Strong understanding of payer requirements, authorization processes, insurance and medical terminology.
  • Possesses specialized level of knowledge and thorough understanding of the systems/applications and subjects listed below:
    • Microsoft 365 (formerly Microsoft Office)
    • EHRs, specifically EPIC, and
    • HIPAA
  • Always puts patients' needs first and ensures that quality and safety requirements are met.
  • Possesses strong listening, communication (written and verbal) and people skills to positively interact with patients, and staff at all levels of the organization.
  • Strong critical thinking skills with the ability to troubleshoot and resolve issues.

About Us
Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation's top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.
Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.
EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status
Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.

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