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 ...
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 ...
Prior Authorization/Scheduling Specialist - Orthopedics
$18.89 - $27.81/hr
... and nurse practitioners equipped with the latest technologies, treatments, and techniques to ... Obtain prior authorizations of surgical procedures. Verify benefits and eligibility on payer ...
Prior Authorization/Scheduling Specialist - Orthopedics
$18.89 - $27.81/hr
... and nurse practitioners equipped with the latest technologies, treatments, and techniques to ... Obtain prior authorizations of surgical procedures. Verify benefits and eligibility on payer ...
Prior Authorization/Scheduling Specialist - Orthopedics
Moorestown, NJ · On-site
$18.89 - $27.81/hr
... and nurse practitioners equipped with the latest technologies, treatments, and techniques to ... This position is responsible for obtaining prior authorizations for surgical procedures and ...
Prior Authorization/Scheduling Specialist - Orthopedics
Moorestown, NJ · On-site
$18.89 - $27.81/hr
... and nurse practitioners equipped with the latest technologies, treatments, and techniques to ... This position is responsible for obtaining prior authorizations for surgical procedures and ...
Authorization Integrity Specialist - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ
Lawrence Township, NJ · On-site
$19 - $25.50/hr
Registered Nurse (RN) license preferred. Certification or license in surgical or diagnostic procedures Experience: Three years' hospital revenue cycle, prior authorization, patient access financial ...
Authorization Integrity Specialist - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ
Lawrence Township, NJ · On-site
$19 - $25.50/hr
Registered Nurse (RN) license preferred. Certification or license in surgical or diagnostic procedures Experience: Three years' hospital revenue cycle, prior authorization, patient access financial ...
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 ...
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 ...
Nurse, Virtual RN *$5000 Signing Bonus*
New Castle, DE · On-site +1
The RN is responsible for evaluating and assessing patient's health care needs based on nurse ... prior authorization; identifying and seeking solutions for barriers to care 3. Provide telephonic ...
Nurse, Virtual RN *$5000 Signing Bonus*
New Castle, DE · On-site +1
The RN is responsible for evaluating and assessing patient's health care needs based on nurse ... prior authorization; identifying and seeking solutions for barriers to care 3. Provide telephonic ...
Registered Nurse (RN) - Clinical Coordinator (No Bedside)
Philadelphia, PA · On-site
$80K - $100K/yr
Guide patients through insurance, prior authorizations, and medication access * Coordinate with ... Active RN license (any U.S. state) * Bachelor's Degree (required) * 3+ years of clinical experience ...
Quick apply
Registered Nurse (RN) - Clinical Coordinator (No Bedside)
Philadelphia, PA · On-site
$80K - $100K/yr
Guide patients through insurance, prior authorizations, and medication access * Coordinate with ... Active RN license (any U.S. state) * Bachelor's Degree (required) * 3+ years of clinical experience ...
Registered Nurse (RN) - Non-Bedside / Office Setting
Cornwells Heights, PA · On-site
$80K - $100K/yr
Guide patients through insurance, prior authorizations, and medication access * Coordinate with ... Active RN license (any U.S. state) * Bachelor's Degree (required) * 3+ years of clinical experience ...
Quick apply
Registered Nurse (RN) - Non-Bedside / Office Setting
Cornwells Heights, PA · On-site
$80K - $100K/yr
Guide patients through insurance, prior authorizations, and medication access * Coordinate with ... Active RN license (any U.S. state) * Bachelor's Degree (required) * 3+ years of clinical experience ...
Travel Nurse RN - Med Surg
Philadelphia, PA · On-site
$1.5K - $1.6K/wk
... prior authorization follow-up * Support patients with questions related to diabetes, thyroid ... RN opportunity in Plainsboro and support high-quality specialty care in a patient-focused ...
Travel Nurse RN - Med Surg
Philadelphia, PA · On-site
$1.5K - $1.6K/wk
... prior authorization follow-up * Support patients with questions related to diabetes, thyroid ... RN opportunity in Plainsboro and support high-quality specialty care in a patient-focused ...
Ambulatory Nurse, Cardiology
Exton, PA · On-site
Could you be our next Ambulatory Registered Nurse with Lankenau Heart Group in Downingtown, PA. Why ... prior authorization workflows, and coordination of care within an outpatient setting preferred.
Ambulatory Nurse, Cardiology
Exton, PA · On-site
Could you be our next Ambulatory Registered Nurse with Lankenau Heart Group in Downingtown, PA. Why ... prior authorization workflows, and coordination of care within an outpatient setting preferred.
Ambulatory Nurse, Cardiology
Exton, PA · On-site
Could you be our next Ambulatory Registered Nurse with Lankenau Heart Group in Downingtown, PA. Why ... prior authorization workflows, and coordination of care within an outpatient setting preferred.
Ambulatory Nurse, Cardiology
Exton, PA · On-site
Could you be our next Ambulatory Registered Nurse with Lankenau Heart Group in Downingtown, PA. Why ... prior authorization workflows, and coordination of care within an outpatient setting preferred.
... prior authorization; identifying and seeking solutions for barriers to care 3. Provide telephonic ... Active, unencumbered Registered Nurse licensure in the State of Delaware or compact state
... prior authorization; identifying and seeking solutions for barriers to care 3. Provide telephonic ... Active, unencumbered Registered Nurse licensure in the State of Delaware or compact state
... prior authorization; identifying and seeking solutions for barriers to care 3. Provide telephonic ... Active, unencumbered Registered Nurse licensure in the State of Delaware or compact state
... prior authorization; identifying and seeking solutions for barriers to care 3. Provide telephonic ... Active, unencumbered Registered Nurse licensure in the State of Delaware or compact state
Why work as an Ambulatory Registered Nurse? Make an Impact! Join a trusted cardiology practice ... prior authorization workflows, and coordination of care within an outpatient setting preferred.
Why work as an Ambulatory Registered Nurse? Make an Impact! Join a trusted cardiology practice ... prior authorization workflows, and coordination of care within an outpatient setting preferred.
Ambulatory Nurse, Cardio OB
Wynnewood, PA · On-site
... prior authorization workflows, and coordination of care within an outpatient setting preferred ... RN license. 2. Provider BLS through the American Heart Association or American Red Cross required.
Ambulatory Nurse, Cardio OB
Wynnewood, PA · On-site
... prior authorization workflows, and coordination of care within an outpatient setting preferred ... RN license. 2. Provider BLS through the American Heart Association or American Red Cross required.
... prior authorization workflows, and coordination of care within an outpatient setting preferred ... RN license. 2. Provider BLS through the American Heart Association or American Red Cross required.
... prior authorization workflows, and coordination of care within an outpatient setting preferred ... RN license. 2. Provider BLS through the American Heart Association or American Red Cross required.
Ambulatory Nurse, Cardio OB
Wynnewood, PA · On-site
... prior authorization workflows, and coordination of care within an outpatient setting preferred ... RN license. 2. Provider BLS through the American Heart Association or American Red Cross required.
Ambulatory Nurse, Cardio OB
Wynnewood, PA · On-site
... prior authorization workflows, and coordination of care within an outpatient setting preferred ... RN license. 2. Provider BLS through the American Heart Association or American Red Cross required.
This role will also decrease the Division of Medicine (DOM) prior authorization denial rate, which ... Multistate RN License within 6 months of hire required. Managed Care experience preferred.
Quick apply
This role will also decrease the Division of Medicine (DOM) prior authorization denial rate, which ... Multistate RN License within 6 months of hire required. Managed Care experience preferred.
This role will also decrease the Division of Medicine (DOM) prior authorization denial rate, which ... Multistate RN License within 6 months of hire required. Managed Care experience preferred.
Quick apply
This role will also decrease the Division of Medicine (DOM) prior authorization denial rate, which ... Multistate RN License within 6 months of hire required. Managed Care experience preferred.
Registered Nurse
Philadelphia, PA · On-site
Complete and submit prior authorizations for imaging medication Nexplanon ParaGard and other ... Graduated from an accredited School of Nursing as registered nurse or one year of nursing ...
Registered Nurse
Philadelphia, PA · On-site
Complete and submit prior authorizations for imaging medication Nexplanon ParaGard and other ... Graduated from an accredited School of Nursing as registered nurse or one year of nursing ...
Prior Authorization Rn information
See Philadelphia, PA salary details
$7.52 - $13.45
0% of jobs
$13.45 - $19.38
0% of jobs
$19.38 - $25.32
4% of jobs
$25.32 - $31.25
18% of jobs
$32.03 is the 25th percentile. Wages below this are outliers.
$31.25 - $37.18
20% of jobs
The median wage is $39.62 / hr.
$37.18 - $43.11
18% of jobs
$48.45 is the 75th percentile. Wages above this are outliers.
$43.11 - $49.04
16% of jobs
$49.04 - $54.97
10% of jobs
$54.97 - $60.91
6% of jobs
$60.91 - $66.84
4% of jobs
$66.84 - $72.77
3% of jobs
$7
$42
$72
How much do prior authorization rn jobs pay per hour?
As of Jul 15, 2026, the average hourly pay for prior authorization rn in Philadelphia, PA is $42.63, 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 do prior authorization nurses do?
Prior authorization nurses review medical documentation and communicate with healthcare providers and insurance companies to obtain approval for specific treatments, medications, or procedures. They ensure that requests meet insurance criteria, often using electronic health records and authorization systems, to facilitate timely patient care.
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?
| Aspect | Prior Authorization Rn | Medical Coder |
|---|---|---|
| Credentials | RN license, possibly certifications in case management or utilization review | Certification in coding (CPC, CCS), no RN license required |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Medical offices, hospitals, insurance companies |
| Primary Responsibilities | Reviewing and obtaining prior authorizations for treatments and procedures | Translating 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.
How to make $300,000 as a nurse?
A Prior Authorization RN can increase earnings by gaining specialized certifications, working in high-paying healthcare settings, or taking on overtime and extra shifts. Developing expertise in insurance processes and healthcare regulations can also lead to higher-paying roles or consulting opportunities.
How to make an extra 2000 a month as a nurse?
A Prior Authorization RN can increase income by taking on overtime shifts, working in high-demand specialties, or obtaining certifications to qualify for higher-paying roles. Additionally, freelance consulting or remote review work can provide supplementary income 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.
More about Prior Authorization Rn jobs
What are popular job titles related to Prior Authorization Rn jobs in Philadelphia, PA? For Prior Authorization Rn jobs in Philadelphia, PA, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Rn jobs in Philadelphia, PA look for? The top searched job categories for Prior Authorization Rn jobs in Philadelphia, PA are:
What cities near Philadelphia, PA are hiring for Prior Authorization Rn jobs? Cities near Philadelphia, PA with the most Prior Authorization Rn job openings:
Registered Nurse RN (Precertification/Prior-Authorization)
Trenton, NJ • On-site
Contractor
Re-posted 16 hours 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
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