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Prior Authorization Rn Jobs in Chicago, IL (NOW HIRING)

Walgreens

Registered Nurse (RN) Specialty

Deerfield, IL · On-site

$33.75 - $44.75/hr

Reviews prior authorization criteria for specified payers related to defined medications. Evaluates ... Current license/registration as an RN (Registered Nurse) with the State Board of Nursing in the ...

Compass Health Center

Registered Nurse

Chicago, IL · On-site

We are seeking a Registered Nurse to provide compassionate direct patient care to all of our ... Coordinating with insurance companies for medication and diagnostic prior authorizations

Franciscan Alliance

Registered Nurse

Crown Point, IN

Registered Nurse (RN) Specialty At Franciscan the Registered Nurse (RNs) Specialty are responsible ... Initiate and follow through on prior authorizations, referrals, and medication refills. * Establish ...

Franciscan Alliance

Registered Nurse

Munster, IN · On-site

Initiate and follow through on prior authorizations, referrals, and medication refills. * Establish ... Registered Nurse (RN) - State Licensing Board Travel is required: Never or Rarely Equal Opportunity ...

Franciscan Alliance

Registered Nurse

Munster, IN · On-site

... (RNs) Specialty are responsible for providing professional nursing care for patients in our ... Initiate and follow through on prior authorizations, referrals, and medication refills. * Establish ...

Flex HR

Registered Nurse (Clinical)

Northfield, IL

Manage test results, medication refills, and prior authorizations * Perform lab draws, specimen ... Current, active Registered Nurse license in the state of Illinois * Minimum two years of hospital ...

Flex HR

Registered Nurse (Clinical)

Lake Forest, IL

Manage test results, medication refills, and prior authorizations * Perform lab draws, specimen ... Current, active Registered Nurse license in the state of Illinois * Minimum two years of hospital ...

Flex HR

Registered Nurse (Clinical)

Lake Forest, IL

Manage test results, medication refills, and prior authorizations * Perform lab draws, specimen ... Current, active Registered Nurse license in the state of Illinois * Minimum two years of hospital ...

Flex HR

Registered Nurse (Clinical)

Lake Forest, IL · On-site

Manage test results, medication refills, and prior authorizations * Perform lab draws, specimen ... Current, active Registered Nurse license in the state of Illinois * Minimum two years of hospital ...

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All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Chicago, IL

Prior Authorization Rn information

See Chicago, IL salary details

$7

$43

$74

How much do prior authorization rn jobs pay per hour?

As of Jun 12, 2026, the average hourly pay for prior authorization rn in Chicago, IL is $43.55, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $51.54 per hour, depending on experience, location, and employer.

How to make $300,000 a year as a nurse?

A Prior Authorization RN can earn $300,000 annually by gaining extensive experience, obtaining advanced certifications, and working in high-paying settings such as specialty clinics or insurance companies. Increasing workload, taking on leadership roles, or working overtime can also boost income, but reaching this level typically requires a combination of expertise, efficiency, and strategic employment choices.

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.

Can nurses do prior authorizations?

Prior authorization nurses, often called utilization review nurses or case managers, are qualified to handle prior authorization requests. They review medical documentation, communicate with providers and insurance companies, and ensure compliance with payer requirements, often using electronic health record systems. Certification in case management or utilization review can enhance their ability to perform these tasks effectively.

How to make an extra 2000 a month as a nurse?

A Prior Authorization RN can increase income by taking on additional shifts, working overtime, or offering consulting services to healthcare providers. Developing specialized knowledge in insurance authorization processes and obtaining relevant certifications can also lead to higher-paying opportunities or freelance work 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.
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Prior Authorization Rn jobs near you
Prior Authorization/Clinical Review Nurse (RN)

Prior Authorization/Clinical Review Nurse (RN)

Orsini Healthcare

Elk Grove Village, IL • On-site

$80K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 15 days ago

Job description

Careers with real impact.

Every role at Orsini moves a patient closer to life-changing therapy. We partner with biopharma innovators, healthcare providers, and payers to make access simple, compassionate, and reliable - so no patient is left behind. Make your next role matter.

ABOUT ORSINI

Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behindâ„¢.

CORE VALUES

At the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.


OUR MISSION

Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.  


COMPENSATION & LOCATION

The salary for this role is $80,000.

This position is based out of our Elk Gove Village location.
POSITION SUMMARY

The Prior Authorization/Clinical Review Nurse (RN) is responsible for reviewing clinical documentation, evaluating medical necessity, and obtaining prior authorizations for prescribed medications, treatments, and procedures. This role ensures timely, accurate processing of authorization requests to support patient access to care, with a focus on specialty pharmacy and rare/orphan disease therapies. The RN collaborates with prescribers, payers, patients, and internal pharmacy teams to navigate complex authorization requirements and ensure compliance with all regulatory and payer guidelines. 
 

ESSENTIAL DUTIES

  • Review patient clinical documentation and verify medical necessity for prior authorization requests in alignment with payer policies and clinical guidelines 
  • Prepare and submit prior authorization requests for specialty medications, infusions, and related therapies 
  • Communicate with insurance companies, physician offices, and internal departments to resolve authorization issues and obtain approvals 
  • Provide clear updates to patients and care teams on the status of prior authorizations 
  • Document all interactions, decisions, and follow-up actions in the patient record and electronic systems 
  • Stay current on payer requirements, formulary changes, and industry regulations affecting prior authorization processes 
  • Monitor and follow up on pending authorizations to prevent treatment delays 
  • Maintain patient confidentiality and comply with HIPAA regulations 
  • Participate in quality improvement initiatives related to the authorization workflow 
Disclaimer: The information written in this job description indicates the general nature and level of work to be performed. This job description is not designed to contain or be interpreted as totally comprehensive of every job duty, responsibility, or qualification required by an employee assigned to this job. While employed in this position, an employee may be required to perform other assignments not listed in this job description. 
 

KNOWLEDGE, SKILLS, AND TRAINING
Required: 

  • Active, unencumbered Registered Nurse (RN) license in Illinois 
  • Associate degree 
  • 2+ years of clinical nursing experience 
  • 1+ year of experience in prior authorization, utilization review, case management, or a related role 
  • Strong knowledge of insurance plans, payer authorization requirements, and medical necessity criteria 
  • Proficiency in EMR/EHR and pharmacy benefit management systems 
  • Excellent communication and critical thinking skills 

Preferred: 

  • Experience in specialty pharmacy, infusion services, or rare disease care coordination 
  • Prior work in a managed care or payer environment 
  • Prior experience with CoverMyMeds for clinical question submissions 

EMPLOYEE BENEFITS
We offer a comprehensive benefits package designed to support your health, financial security, and overall well-being:

  • Medical Coverage, Dental, and Vision Coverage
  • 401(k) with employer match
  • Accident and Critical Illness coverage
  • Company-paid life insurance options
  • Generous PTO, paid holidays, and floating holidays
  • Tuition reimbursement program.

 

Equal Employment Opportunity

Orsini Rare Disease Pharmacy Solutions is committed to the principle of Equal Employment Opportunity for all employees and applicants. It is our policy to ensure that both current and prospective employees are afforded equal employment opportunity without consideration of race, religious creed, color, national origin, nationality, ancestry, age, sex, marital status, sexual orientation, or present or past disability (unless the nature and extent of the disability precludes performance of the essential functions of the job with or without a reasonable accommodation) in accordance with local, state and federal laws.

Americans with Disabilities Act

Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.

E-Verify Participation Notice

We participate in the federal E-Verify program to confirm the identity and employment eligibility of all newly hired employees.

All offers of employment are contingent upon the successful completion of Form I-9 and verification through the E-Verify system.

For more information about E-Verify, please review the official notices below:

E-Verify Participation Poster (English & Spanish):
https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf

Right to Work Poster (English & Spanish):
https://www.e-verify.gov/sites/default/files/everify/posters/IER_RightToWorkPoster.pdf

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