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Prior Authorization Rn Jobs in Washington (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 ...

MFA Co

Prior-Authorization Technician- Pharmacy

Arlington, VA · On-site

$20.25 - $24.50/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 ...

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 ...

UHS

Intake Registered Nurse

Washington, DC · On-site

$37.60 - $56.40/hr

The RN - Intake works with the Business Office regarding patient financial data and verification and prior authorization of insurance benefits as needed, as well as with the UR Department for the ...

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How much do prior authorization rn jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for prior authorization rn in Washington is $47.85, according to ZipRecruiter salary data. Most workers in this role earn between $35.67 and $56.63 per hour, depending on experience, location, and employer.

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.

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 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 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 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.

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Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in Washington as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $99,519 per year, or $47.8 per hour.

Prior Authorization Specialist

Bowie, MD • On-site

Maryland Primary Care Physicians
Outpatient Health Care • 51 - 200 employees
Learn more about Maryland Primary Care Physiciansexternal

$20 - $24/hr

Full-time

Posted 15 days ago

Key responsibilities

  • Obtain prior authorizations for diagnostic imaging, prescription medications, Home Health, and Durable Medical Equipment.

  • Receive referral requests from providers and Health Plans representatives, process medical services requests, and complete related clerical duties.

  • Coordinate approved services with providers, health plans, and other relevant parties, ensuring proper documentation and communication.

Job description

Description:

Description

The Prior Authorization Coordinator is responsible for servicing the needs of patients, providers, and the Health Plans representatives, by effectively handling referrals from providers to facilitate the clinical review, issue authorizations and coordination of referrals services utilizing pre-approved screening criteria in compliance with contracted Client's requirements and adopted clinical guidelines. Handles the more complex requests for treatment and authorization requests. Conducts searches on authorization requests to handle complex Provider inquiries.

Job Duties

  • Obtain prior authorizations for diagnostic imaging, prescription medications, Home Health, and Durable Medical Equipment.
  • Receives referral requests from providers and Health Plans representatives. Assist in processing medical services request. Completes clerical duties related to the processing of Authorization Requests and Provider Referrals.
  • Verifies member’s eligibility and benefits with subsequent notification to designated staff of eligibility issues.
  • Inputs all requests for services received via fax or phone into the system accurately for electronically generated authorization and tracking.
  • Provides services authorizations to providers per UM Departmental Policy and Procedures and specific contracted Client's process on a timely manner.
  • Requests submission of appropriate medical records according to established criteria for requested service(s) in accordance with the corresponding Policy and Procedure.
  • Notifies required parties within the appropriate timeframe for routine and urgent requests for services.
  • Research member history for duplications and consideration of authorization limits.
  • Verifies fax numbers and system updates. Communicates with requesting provider for any identified need to clarify a request for an authorization, such as CPT codes, ICD10, requested timeframes and member’s demographics.
  • Provides effective departmental communication with both internal and external sources.
  • Forwards Authorizations to appropriate department staff in terms of eligibility and other coverage, pricing, and benefit issues.
  • Scans, attaches, reviews and effectively works with electronic images as part of the authorization process. Including recording the required information from attachments into the authorization fields.
  • Collaborates with Supervisor and Insurance companies to resolve complex authorization issues.
  • Appropriately forwards all referral requests to the next level of clinical review as applicable and after verifying for completeness and appropriateness.
  • Coordinates approved outpatient surgical procedures in specialist's office and/or outpatient surgical facilities with health plan's authorization department when applicable.
  • Coordinates approved services with Home Health and Durable Medical Equipment Providers, Nurse Care Managers, Plan discharge Planners and Plan Members as delegated or required by Plan.
  • Is resource person for PCP to refer to network specialist(s).
  • Maintains appropriate logs, records, and reports as established.
  • Documents and communicates areas of concern to supervisor.
  • Identifies providers who show an educational need to follow national, state and plan requirements.
  • Adheres to company HIPAA policies and procedures. Identifying, maintaining and protecting sensitive HIPAA information (PHI) and following procedures to ensure the security of such information.
  • Perform other duties as assigned.


Requirements:

Education

  • High school diploma or general education degree (GED); Medical coding or authorization education/training preferred.

Experience & Skills Required

  • Required: computer literacy and advanced data entry capacity (++45 wpm)
  • Required: 3 - 5 years’ experience in a medical office setting
  • Experience processing/managing referrals or authorization requests in a Utilization Management department for 2 years, demonstrating production and accuracy well above the minimum required goals, or an equivalent combination of education and experience, which would provide the required knowledge, skills and abilities may also be qualifying.

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