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Prior Authorization Rn Jobs in Philadelphia, PA (NOW HIRING)

IntePros

Utilization Management RN

Philadelphia, PA · On-site

PA RN License Required We are seeking an experienced Care Management Coordinator to join our ... Prior Authorization. * Strong understanding of medical necessity review, healthcare regulations ...

IntePros

Utilization Review Nurse

Philadelphia, PA · On-site

Active Pennsylvania Registered Nurse (RN) license required. * Previous experience in Utilization Management, Care Management, Case Management, or Prior Authorization. * Strong understanding of ...

New

Jefferson

Authorization Representative

Abington, PA · On-site

$16.50 - $21/hr

Monitors work queues and patient schedules to ensure accurate authorization are in place prior to each visit. * Maintains compliance with benchmark metrics for accounts registered versus scheduled ...

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All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Philadelphia, PA

Prior Authorization Rn information

See Philadelphia, PA salary details

$7

$42

$72

How much do prior authorization rn jobs pay per hour?

As of Aug 5, 2026, the average hourly pay for prior authorization rn in Philadelphia, PA is $42.61, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $50.43 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 Philadelphia, PA as of July 2026, with employment types broken down into 83% Full Time, 11% Part Time, and 6% Contract. Highlights an 100% In-person job distribution, with an average salary of $88,636 per year, or $42.6 per hour.

Registered Nurse RN (Precertification/Prior-Authorization)

Integrated Resources INC

Trenton, NJ

Contractor

Re-posted 22 days ago

Job description

Company Description

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Job Description:

**Looking for a RN with Prior Authorization or Pre-Certification not case management experience.

Clinical experience on a medical surgical unit/surgical area or home care experience.

Job Summary:

This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management.

Responsibilities:

1. Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay.

2. Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.

3. Coordinates and assists in implementation of plan for members.

4. Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate. Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome.

5. Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.

6. Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.

7. Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.

8. Encourages member participation and compliance in the case/disease management program efforts.

9. Documents accurately and comprehensively based on the standards of practice and current organization policies.

10. Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care.

11. Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.

12. Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.

13. Completes other assigned functions as requested by management.

Core Individual Contributor Competencies. Personal and professional attributes that are critical to successful performance for Individual Contributors:

Customer Focus, Accountable, Learn, Communicate.


Knowledge:

  • Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications.
  • Prefers working knowledge of case/care management principles.
  • Prefers working knowledge of principles of utilization management.
  • Prefers basic knowledge of health care contracts and benefit eligibility requirements.
  • Prefers knowledge of hospital structures and payment systems.

Skills and Abilities:

  • Analytical
  • Compassion
  • Interpersonal & Client Relationship Skills
  • Judgment
  • Listening
  • Planning/Priority Setting
  • Problem Solving
  • Team Player
  • Time Management
  • Written/Oral Communication & Organizational Skills
Qualifications

Education/Experience

1. Requires an associate's or bachelor's degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school.

2. Requires a minimum of two (2) years clinical experience.

Additional licensing, certifications, registrations:

1. Requires an active New Jersey Registered Nurse License.

Additional Information

Warm Regards

Harry Chaudhary

"Clinical Recruiter"

Integrated Resources, Inc.

IT Life Sciences Allied Healthcare CRO

Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I

Direct# 732-429-1869

(BOARD) # 732-549-2030 - Ext - 207

Integrated Resources logo

About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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