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

Kaplan, Inc.

Hospice Registered Nurse, RN

Lisle, IL · On-site

NOTICE : * Successful completion of a drug screen prior to employment is part of our background ... By submitting your application, you are confirming that you are legally authorized to work in the ...

Kaplan

Hospice Registered Nurse, RN

Elmhurst, IL

NOTICE : * Successful completion of a drug screen prior to employment is part of our background ... By submitting your application, you are confirming that you are legally authorized to work in the ...

Kaplan, Inc.

Hospice Registered Nurse, RN

Lisle, IL · On-site

NOTICE : * Successful completion of a drug screen prior to employment is part of our background ... By submitting your application, you are confirming that you are legally authorized to work in the ...

Kaplan, Inc.

Hospice Registered Nurse, RN

Waukegan, IL · On-site

NOTICE : * Successful completion of a drug screen prior to employment is part of our background ... By submitting your application, you are confirming that you are legally authorized to work in the ...

Kaplan, Inc.

Hospice Registered Nurse, RN

Elmhurst, IL · On-site

NOTICE : * Successful completion of a drug screen prior to employment is part of our background ... By submitting your application, you are confirming that you are legally authorized to work in the ...

Kaplan

Hospice Registered Nurse, RN

Northbrook, IL

NOTICE : * Successful completion of a drug screen prior to employment is part of our background ... By submitting your application, you are confirming that you are legally authorized to work in the ...

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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
CASE MANAGER- RN required

CASE MANAGER- RN required

Methodist Hospitals

Merrillville, IN

Full-time

Posted 13 days ago

Job description

Case Manager is responsible for chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of resources and optimal outcomes. Responsible for coordinating the patient's plan of care from admission to discharge and or transfer to another level of care.


PRINCIPAL DUTIES AND RESPONSIBILITIES(*Essential Functions)

  1. Applies to individual case, through chart review, third payer regulations that govern admissions, continued stay, and discharge, i.e. IS/SI.
  2. Collects data related to clinical improvement initiatives for the purpose of developing action plans.
  3. Conducts concurrent chart reviews to assure complete and accurate medical records documentation.
  4. Coordinates the patient's plan of care with all members of the health care team including the patient, caregiver, and or family members and case management.
  5. Demonstrates proficiency in patient assessment and documentation.
  6. Interviews and assesses patients to determine potential barriers to timely discharge/transfer to another level of care.
  7. Provides all payers with accurate, updated information.
  8. Obtains covered stay certification and prior authorization as appropriate.
  9. Refers cases when appropriate to physician advisor for medical necessity, continued stay, physician education and appropriate level of care.
  10. Refers to Social Services when appropriate.
  11. Ensures discharge planning to the appropriate level of care, sub-acute, hospital units, and outpatient services.
  12. Supports hospital CQI programs by participation on relevant teams.

JOB SPECIFICATIONS(Minimum Requirements)
KNOWLEDGE, SKILLS, AND ABILITIES

  • Knowledge of appropriate and timely return transition levels of care.
  • Knowledge of CARF, Regulatory Agencies and State Board of Health, Long Term Care, Acute Care and Ambulatory Care Standards.
  • Demonstrates excellent interpersonal and problem-solving skills.
  • Demonstrates self-directed, goal orientated and customer service.
  • Excellent organizational and prioritization skills to meet deadlines.
  • Capable of functioning effectively across service lines.
  • Ability to assess and interpret data about the patient's status in order to identify each patients age, specific needs and provide the care needed by the infant, child, adolescent, young adult, middle adult and geriatric patient.
  • Ability to independently perform comprehensive chart review with subsequent abstraction or relevant information including interpretation of lab results, EKG and other medical tests.
  • Ability to communicate effectively both verbally and in writing.
  • Ability to provide compassionate patient care orientated with an effort for timeliness and accuracy in the delivery of service.
  • Ability to respond positively to the needs of patients and family.
  • Addresses customer concerns in a private, respectful and calm manner.


EDUCATION

  • Bachelors Nursing Required
  • 3 Required RN Case Manager Expereince 
  • Licensed Registered Nurse
  • Certified Cardiac Pulmonary Resuscitation


STANDARDS OF BEHAVIOR
Meets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.
CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCE
Demonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.
DISCLAIMER - The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. The statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required.

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About Methodist Hospitals

Sourced by ZipRecruiter

Methodist Hospitals is a reputable institution in the healthcare and medical industry with its base in Gary, Indiana, United States. A trusted name in comprehensive medical services, the organization is primarily known for its robust offering in the fields of emergency and acute medical care, tracking back its foundational roots to the year 1923. Catholic nun Sister Gesuina set up the hospital with the sole mission of providing affordable healthcare services to the residents of Gary. Today, their mission stays true to promoting health, healing, and well-being in the communities they serve, encompassing a diverse representation of races, ethnicities, genders, ages, religions, abilities, and sexual orientations.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Gary, IN, US

Year founded

1923

Social media

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