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Prior Authorization Rn Jobs in South Carolina (NOW HIRING)

Palmetto Infusion

Prior Authorization Specialist

Columbia, SC · On-site

$16.75 - $22.25/hr

Works closely with Nurse Manager and Reimbursement team in providing and promoting customer service ... authorizations. * Proficient at partner programs (i.e.: MS Outlook, Word, Excel). * Ability to cope ...

Palmetto Infusion

Prior Authorization Specialist

Columbia, SC · On-site

$14.75 - $19.50/hr

Works closely with Nurse Manager and Reimbursement team in providing and promoting customer service ... authorizations. * Proficient at partner programs (i.e.: MS Outlook, Word, Excel). * Ability to cope ...

Oak St. Health

Registered Nurse

Columbia, SC · On-site

$54K - $116K/yr

Registered Nurse We're building a world of health around every individual -- shaping a more ... prior authorizations. * Conduct thorough and accurate reviews of patient medications and update as ...

CVS Health

Registered Nurse

Columbia, SC · On-site

$54K - $116K/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 ...

CVS Health

Registered Nurse

Columbia, SC · On-site

$54K - $116K/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 ...

Trinityhealth

Manage medication refills, test results, referrals, and prior authorizations. * Identify preventive ... Valid, unrestricted RN license in the State of Michigan. Valid CPR certification. * MINIMUM ...

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All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in South Carolina

Prior Authorization Rn information

See South Carolina salary details

$6

$39

$66

How much do prior authorization rn jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for prior authorization rn in South Carolina is $39.20, according to ZipRecruiter salary data. Most workers in this role earn between $29.23 and $46.39 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.
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Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in South Carolina as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $81,537 per year, or $39.2 per hour.

Prior Authorization Associate

Lexington Medical Center

Columbia, SC

$17 - $21.25/hr

Full-time

Medical, Dental, Life, Retirement

Re-posted 29 days ago

Lexington Medical Center rating

6.9

Company rating: 6.9 out of 10

Based on 104 frontline employees who took The Breakroom Quiz

552nd of 1,059 rated hospitals

Job description

 
PN Access and Authorizations
Full Time
Day Shift
M-F 8a-5p

Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence in nursing care. Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the region's third largest employer.

Lexington Health also includes an accredited Cancer Center of Excellence, the state's first HeartCARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer's care center. Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship.

Job Summary

Responsible for accurately authorizing referrals prior to patient appointments. Utilizes Epic Referral Work Queues, Experian Real Time Authorization (RTA), phone, payer websites and fax to complete prior authorizations for imaging and specialty services. Communicates authorization updates to appropriate departments. Verifies all pertinent clinical information is submitted in order for authorization to be processed accurately. Documents all information within the referral record and chart in Epic to include approvals, denials, peer-to-peers and pending authorizations.

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 6 months of referral and/or authorization experience
Substitutable Education & Experience: None.
Required Certifications/Licensure: None.
Required Training: Strong Medical Terminology and Insurance Knowledge; Knowledge of ICD-10 and CPT Coding

Essential Functions
  • Understands the referral process start to finish and acknowledges authorization as an important step in the overall process.
  • Meets authorization volume and quality standards set monthly. 
  • Thoroughly reviews patient charts in Epic, submits the appropriate clinicals for authorization to the correct payer/third party vendor, obtains final determination from payer and enters information into EPIC. 
  • Utilizes Experian RTA system to obtain authorization and verifies authorization completion within system.
  • Communicates all necessary authorization updates and status changes to the appropriate department(s).
  • Communicates peer-to-peer requests to PN practices for providers/clinical staff to complete in order to obtain an authorization from payer.
Duties & Responsibilities
  • Partners with LMC departments and insurance companies to provide quality care to LMC patients through the authorization process prior to patients' date of service.
  • Escalates difficult issues, problems, questions and process improvement suggestions to management.
  • Works with team to ensure timely process of authorizations. Participates in team problem solving activities, focuses on production and quality.
  • Performs other duties as assigned.

We are committed to offering quality, cost-effective benefits choices for our employees and their families:

  • Day ONE medical, dental and life insurance benefits 
  • Health care and dependent care flexible spending accounts (FSAs)
  • Employees are eligible for enrollment into the 403(b) match plan day one.  LHI matches dollar for dollar up to 6%.
  • Employer paid life insurance - equal to 1x salary
  • Employee may elect supplemental life insurance with low cost premiums up to 3x salary 
  • Adoption assistance
  • LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
  • Tuition reimbursement
  • Student loan forgiveness

Equal Opportunity Employer
It is the policy of Lexington Health to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. Lexington Health strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. Lexington Health endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee's desires and abilities and the hospital's needs.

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