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Prior Authorization Rn Jobs in Rhode Island (NOW HIRING)

DOCS Health

Registered Nurse

Providence, RI · On-site

Registered Nurse Opportunity Attention all Registered Nurses, we are calling you to partner with us ... Interview military personnel to determine current and prior medical concerns. * Identify any ...

DOCS Health

Registered Nurse

Providence, RI · On-site

Description Attention all Registered Nurses, we are calling you to partner with us as independent ... Interview military personnel to determine current and prior medical concerns. * Identify any ...

DOCS Health

Registered Nurse

Providence, RI · On-site

Attention all Registered Nurses, we are calling you to partner with us as independent contractors ... Interview military personnel to determine current and prior medical concerns. * Identify any ...

DOCS Health

Registered Nurse

Providence, RI · On-site

Attention all Registered Nurses, we are calling you to partner with us as independent contractors ... Interview military personnel to determine current and prior medical concerns. * Identify any ...

Brown University Health

Referral Specialist

Providence, RI · On-site

$19.03 - $31.39/hr

Documents any communication with referring providers, patients and/or Clinic (MD, RN, etc.) in the ... prior authorization (i.e. office, procedural, drug, etc.). Maintains current knowledge of insurer ...

Veracity

RN - Emergency Room (Contractor)

Warwick, RI · On-site

RN - Emergency Room (Contractor) Location: Warwick, RI 02886 (Onsite) Positions: 2 Contract Type ... Current Work Authorization (US Citizen / GC / H1B / Other): Expected Hourly Rate: Is it W2 / C2C?

Brownhealth

Referral Specialist

Providence, RI

Documents any communication with referring providers, patients and/or Clinic (MD, RN, etc.) in the ... prior authorization (i.e. office, procedural, drug, etc.). Maintains current knowledge of insurer ...

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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 Coordinator

Referral Coordinator

The Providence Community Health Centers, Inc.

Providence, RI • On-site

$18.25 - $23.75/hr

Full-time

Posted 27 days ago

Job description

A Referral Coordinator works collaboratively with physicians, practitioners, counsellors, nurse case managers and other departments to coordinate transfer of care between PCHC providers and community specialists. This person functions as the problem solver for their clinical team – assisting with administrative duties such as completing and expediting referrals, medication prior authorization from different insurance companies, assisting with completion of routine forms, and other logistical duties.

Duties & Responsibilities:

  • Monitors the electronic health record to receive and process requests for referrals and diagnostic imaging prior authorizations during standard clinical hours. Able to prioritize and successfully process referrals and related forms from multiple providers.
  • Proactively reviews new referrals and diagnostic imaging prior-authorization requests for completeness and accuracy. Able to interpret standard insurance guidelines to identify incomplete referrals before processing, and communicates directly with the care team regarding any necessary testing or records required for approval.
  • Has a clear understanding of insurance plans, with knowledge of covered services and community specialists within the insurance company’s network.
  • Functions as a liaison between insurance companies and care teams for high risk referrals and diagnostic imaging requests. Accesses insurance companies web-based program(s) to check the status of pending prior authorizations. Escalates all unresolved high risk referral issues back to the care team in a timely manner.

Qualifications:

  • Excellent oral and written communication skills and the ability to effectively communicate medical and behavioral health conditions to community specialists.
  • Ability to work independently and as part of a health care team.
  • Basic knowledge/experience in navigating web based portals required, as well as, Microsoft Office products such as Excel, Word, and Outlook.
  • Attention to detail required.
  • Medical Terminology required.
  • Proficiency in use of the PCHC electronic health record and scheduling system, preferred.
  • Ability to develop positive relationships with community specialists and insurance carriers.
  • Experience with processing prior authorizations and referrals, preferred.
  • Knowledge of state and federal health care programs, including Medicaid, Medicare and other public benefits programs, preferred.
  • Knowledge of HIPAA regulations and ability to maintain strict confidentiality of patient health information at all times.
  • Experience working with the under-served and uninsured populations.
  • Access to reliable transportation.
  • Background check/Life Links access required.
  • Ability to communicate with people of various diverse backgrounds in a sensitive and compassionate way.

Education:

  • Minimum of an Associate’s Degree and/or completion of a medical training program.
  • Prior experience working in an ambulatory care center.

PCHC is EOE/M/F/D/V/SO