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Prior Authorization Rn Jobs in Elk Grove, CA (NOW HIRING)

United Health Systems

Nurse Practitioner

Vacaville, CA · On-site

The CDCR/CCHCS Medical Standards of Care shall be used as a reference when prior authorization is ... To become an NP, one must be a registered nurse (RN), hold a Bachelor of Science in Nursing (BSN ...

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Prior Authorization Rn information

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$7

$44

$75

How much do prior authorization rn jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for prior authorization rn in Elk Grove, CA is $44.41, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $52.55 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 Elk Grove, CA as of July 2026, with employment types broken down into 100% Full Time. Highlights an 59% In-person, 10% Hybrid, and 31% Remote job distribution, with an average salary of $92,372 per year, or $44.4 per hour.

RN Supervisor UM Prior Auth

Dignity Health Medical Foundation

Rancho Cordova, CA • Remote

$53.46 - $79.52/hr

Full-time

Re-posted 6 days ago

Job description


Job Summary and Responsibilities

As our Supervisor of Utilization Management (UM), under the guidance and supervision of the department Manager/Director, you will be responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic Medical Group through an interdisciplinary process that provides a clinical and financial approach through the continuum of care.

Every day you will promote the quality and cost effectiveness of medical care by ensuring department staff are applying clinical acumen and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision, this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory guidelines.

To be successful in this role, you will have a strong knowledge of Utilization Management, strong leadership skills, and a passion for high-quality patient care.

As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories.

This position is primarily work-from-home within driving distance of Sacramento, CA, as there may be occasional onsite meetings.

This position will work rotating weekends.

  • Responsible for day to day operations of the Pre-Authorization team to include timely response and appropriate evaluation of referral reviews, correct selection of criteria, accurate prep to the UM Physician reviewer when indicated, timely verbal and written documentation, and completion of the file.
  • Ensures adequate staffing and assignments and adjusts workflow as needed to meet department goals.  Manages team schedule including requests for time off and assurance of coverage during physician office hours.
  • Organizes, structures, and chairs a minimum of one pre-authorization meeting per month, including other staff as appropriate.
  • Motivates and coaches staff to include new-hire training, problem solving, and special projects.  Assists manager with performance activities to include monitoring, coaching, educating, and providing feedback to team.
  • Ensures UM Physicians are provided the relevant information needed to accurately review a referral. Fosters the relationship between the Pre- Authorization team and the Medical Director and Physician Reviewers.
  • Tracks cost savings from activities over time to evaluate success of programs. Maintains or removes programs based on organization and department goals. Develops reports for leadership as required.
Job Requirements

Required:

  • Five (5) years clinical experience
  • Three (3) years Utilization experience in health plan/UM operations, acute or subacute utilization review
  • Bachelors degree, or equivalent experience
  • Clear and current CA Registered Nurse (RN) license
  • Ability to demonstrate leadership and management skills
  • Knowledge of all applicable federal and state regulations as well as accreditation standards
  • Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory requirements
  • Must have the ability to monitor, compile, report and analyze data/statistics
  • Requires excellent human relations, interpersonal and oral/written communication skills
  • Able to recognize and address the needs and concerns of customers
  • Ability to interact with all levels of the organization as well as with external contacts
  • Requires good knowledge and skills with Microsoft Office (ie: Word and Excel) and other computer information systems and applications

Preferred:

  • Seven (7) years UM experience with Charge/Lead/Supervisory/Management experience in Utilization Management department preferred
  • Previous prior authorization experience strongly preferred
  • Managed care experience preferred
  • Experience working with health plan auditors preferred
  • Working knowledge of InterQual preferred
  • Knowledgeable of NCQA and ICE preferred

#DH-LI

Where You'll Work

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. Our 130+ clinics across the state of California deliver high-quality, patient-centric care with an emphasis on humankindness. Through affiliations with Dignity Health hospitals, along with our joint ventures and partnerships, we offer a robust, state-of-the-art health care delivery system in the communities we serve .We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.

One Community. One Mission. One California 

Qualifications:

Required:

  • Five (5) years clinical experience
  • Three (3) years Utilization experience in health plan/UM operations, acute or subacute utilization review
  • Bachelors degree, or equivalent experience
  • Clear and current CA Registered Nurse (RN) license
  • Ability to demonstrate leadership and management skills
  • Knowledge of all applicable federal and state regulations as well as accreditation standards
  • Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory requirements
  • Must have the ability to monitor, compile, report and analyze data/statistics
  • Requires excellent human relations, interpersonal and oral/written communication skills
  • Able to recognize and address the needs and concerns of customers
  • Ability to interact with all levels of the organization as well as with external contacts
  • Requires good knowledge and skills with Microsoft Office (ie: Word and Excel) and other computer information systems and applications

Preferred:

  • Seven (7) years UM experience with Charge/Lead/Supervisory/Management experience in Utilization Management department preferred
  • Previous prior authorization experience strongly preferred
  • Managed care experience preferred
  • Experience working with health plan auditors preferred
  • Working knowledge of InterQual preferred
  • Knowledgeable of NCQA and ICE preferred

#DH-LI

Employment Type: Full Time

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