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Prior Authorization Rn Jobs in Virginia (NOW HIRING)

MFA

Prior-Authorization Technician- Pharmacy

Arlington, VA · On-site

$23.46 - $30.50/hr

Position Summary The Prior Authorization Technician will process prior authorizations and locate ... Certified Nurse Assistant, Medical Assistant, Licensed Practical Nurse) will be considered Physical ...

WPS Health Solutions

Utilization Management RN

Hampton, VA · On-site

$75K - $100K/yr

Have experience reviewing medical and behavioral health prior authorization requests for medical ... Registered Nurse (RN) with current licensure in the state of Wisconsin. * 4 or more years of ...

New

Quadrant

Registered Nurse

Alexandria, VA · On-site

$33/hr

Registered Nurse - Nurse Coordinator Alexandria, VA Pay From: $33 per hour MUST: Experienced ... Obtains prior authorization for medications and urgent patient procedures Assists with ...

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All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Virginia

Prior Authorization Rn information

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$7

$41

$71

How much do prior authorization rn jobs pay per hour?

As of Jul 14, 2026, the average hourly pay for prior authorization rn in Virginia is $41.88, according to ZipRecruiter salary data. Most workers in this role earn between $31.20 and $49.57 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 the most commonly searched types of Prior Authorization Rn jobs in Virginia? The most popular types of Prior Authorization Rn jobs in Virginia are:
What are popular job titles related to Prior Authorization Rn jobs in Virginia? For Prior Authorization Rn jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Rn jobs in Virginia look for? The top searched job categories for Prior Authorization Rn jobs in Virginia are:
Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in Virginia as of July 2026, with employment types broken down into 5% As Needed, 72% Full Time, 21% Part Time, and 2% Contract. Highlights an 100% In-person job distribution, with an average salary of $87,114 per year, or $41.9 per hour.
Prior Authorization Pharmacist

Prior Authorization Pharmacist

Accede Solutions Inc.

Mclean, VA • On-site

$59.75 - $71.75/hr

Other

This job post has expired today. Applications are no longer accepted.

Job description

Prior Authorization (PA) Pharmacist

The Prior Authorization (PA) Pharmacist would facilitate efforts in the review of clinical documentation and the Preferred Drug list (PDL) to determine proper medication therapy. The PA pharmacist will work with internal and external stakeholders in evaluating and continually developing a strategy for Utilization Management.

Responsibilities:

  • Clinical evaluation of medication therapy using established clinical or PDL criteria, drug compendia, and appropriate methods that support the principles of high-quality evidence-based medicine
  • Peer to Peer discussions with medical providers to discuss Prior Authorization reviews.
  • Consultations/Interventions: work with staff in contacting prescribers needing consultation to provide clinical information on prescribing practices that have been identified as outliers. Reviews prior authorizations data and determine opportunities for interventions.
  • Intervention Refinements: Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements.
  • Operations: Contributes to the success of the Clinical Call Centers and Prior Authorization department by assisting with the implementation and management of both written and verbal communications to members and physicians. Is available for consultation on pharmacy-related questions and issues for others within the organization.
  • Quality Improvement: Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities and by contributing on-going consultation and collaboration with product leaders.
  • Medical/Clinical: Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, Clinical Pharmacist, and Clinical Specialty Pharmacist to provide pharmacy expertise.
  • Drug Review: Provides clinical input during the weekly drug file updates, making recommendations on applying utilization controls
  • Other duties as assigned. Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team

Qualifications:

  • Experience in the coordination of and collaboration of work teams preferred.
  • Ability to perform clinical reviews using relevant compendia and clinical trial data.
  • Managed care pharmaceutical service experience a plus.
  • Strong research and implementation skills in practical settings.
  • Analytical skills which can translate into practical and pragmatic recommendations.
  • Strong team orientation with respect for all members.
  • People skills are essential that allow for the successful consultation and collaboration with internal and external stakeholders who do not directly report to this job.

Requirements:

  • PharmD or B.S. in Pharmacy with relevant Specialty background
  • Registered Pharmacist with respective State Licensure
  • 4 years' experience in clinical pharmacy
  • Strong verbal and written communications skills.
  • Highly skilled with Microsoft office products and ability to quickly learn proprietary systems.

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