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

Excela Health

REGISTERED NURSE RN

Greensburg, PA · On-site

The RN coordinates, directs, and actively participates as an effective member of the ... Obtains prior authorizations and/or assists with indigent programs per physician order based on the ...

Excela Health

REGISTERED NURSE RN

Greensburg, PA · On-site

The RN coordinates, directs, and actively participates as an effective member of the ... Obtains prior authorizations and/or assists with indigent programs per physician order based on the ...

Excela Health

REGISTERED NURSE RN

Greensburg, PA · On-site

The RN coordinates, directs, and actively participates as an effective member of the ... Obtains prior authorizations and/or assists with indigent programs per physician order based on the ...

UPMC Health Plan

UM Care Manager (RN)

Pittsburgh, PA · Remote

Experience with prior authorizations preferred. PA RN license preferred. * Strong organizational, task prioritization and problem-solving skills. * Ability to construct grammatically correct reviews ...

Posted today

UPMC Senior Communities

UM Care Manager (RN)

Pittsburgh, PA · On-site

$34.49 - $56.83/hr

Experience with prior authorizations preferred. PA RN license preferred. * Strong organizational, task prioritization and problem-solving skills. * Ability to construct grammatically correct reviews ...

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

Prior Authorization Rn information

See Pittsburgh, PA salary details

$7

$41

$70

How much do prior authorization rn jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for prior authorization rn in Pittsburgh, PA is $41.01, according to ZipRecruiter salary data. Most workers in this role earn between $30.58 and $48.56 per hour, depending on experience, location, and employer.

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.

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 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 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 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.

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Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in Pittsburgh, PA as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, 1% Temporary, and 3% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $85,303 per year, or $41 per hour.

REGISTERED NURSE RN

Greensburg, PA • On-site

Excela Health
Health Care and Social Assistance • 1 - 5K employees
Learn more about Excela Healthexternal

Other

Re-posted 17 days ago

Job description

Job Summary/Overall Objectives
The RN assesses, plans, implements and evaluates the care for a designated group of patients. The RN coordinates, directs, and actively participates as an effective member of the interdisciplinary health care team, contributing to the efficient operation of the unit and promoting positive patient outcomes
Essential Job Functions
  • Maintain professional and technical knowledge by attending education workshops, review professional publications, establish personal networks, and participate in professional societies.
  • Assure quality of care by adhering to therapeutic standards, measuring health outcomes against patient care goals and standards, making or recommending necessary adjustments, and following system/hospital and nursing division's philosophies and standards of care set by state board of nursing, state nurse practice act, and other governing agency regulations.
  • Protect patients and employees by adhering to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations.
  • Document patient care services by charting patient and department records.
  • Maintain continuity among nursing teams by documenting and communicating actions, irregularities, and continuing needs using Nurse Knowledge Exchange techniques.
  • Maintain patient confidence and protects operations by keeping confidential information.
  • Identify patient care requirements by establishing personal rapport with potential and actual patients, and other persons in a position to understand care requirements.
  • Establish a compassionate environment by providing emotional, psychological, and spiritual support to patients, friends, and families.
  • Promote patient's independence by establishing patient care goals, teaching patient/family to understand condition, medications, and self-care skills, and answering questions.
  • Maintain safe and clean working environment by complying with procedures, rules and regulations, calling for assistance from health care support personnel.
  • Resolve patient problems and needs by utilizing multidisciplinary team strategies.
  • Maintain a cooperative relationship among health care teams by communicating information, responding to requests, building rapport, and participating in team continuous quality improvement and problem-solving methods.
  • Contribute to team effort by accomplishing related results as needed.
  • Ensure operation of equipment by completing preventive maintenance requirements by following manufacturer's instructions, troubleshooting malfunctions, calling for repairs, maintaining equipment inventories, and evaluating new equipment and techniques.
  • Maintain nursing supplies inventory by checking stock to determine inventory level, anticipating needed supplies, placing and expediting orders for supplies, verifying receipt of supplies, and using equipment and supplies as needed to accomplish job results.
  • The Registered Nurse may provide direct oversight of the GN, LPN, Technical Partner, ALS Technician, Nurse Extern and Unit Clerks. This oversight includes the Registered Nurse conducting the initial comprehensive assessment and interpreting the assessment to initiate the interprofessional plan of care. This oversight includes support of the delegation of duties that are within the scope and capability of the care team.
  • Prepares forms, copies records, and responds to requests per policies and procedures
  • Assists in maintaining the patient's medical record to facilitate filing and retrieval of information.
  • Participate in staff education.
  • Other related duties as assigned.
Specialty Job Functions
  • Coordinates communications between patients/families and physician practice, pharmacies, specialists, and insurance carriers.
  • Provides advice based on protocols and physician instructions and directs patients to the appropriate level of care.
  • Facilitates patient's access to prescription refills based on physician order.
  • Obtains prior authorizations and/or assists with indigent programs per physician order based on the patient's financial status or insurance coverage.
  • Completes medication reconciliation according to policy
  • Obtains authorizations for diagnostic testing and ancillary services as required.
  • Patient Procedure Preparation
  • Obtains medication hold order from primary care physician as required for scheduling procedure.
  • Provides education tool and teaching specific to procedure ordered.
  • Ensures appropriate order, consent form and patient specific information is completed for scanning/communication to SurgiCenter.
  • Fast Track Orders
  • Reviews fast track orders for completeness - notifies referring office if additional documentation needed
  • Interviews patient via telephone regarding procedure, current medications, medical conditions and provides education specific to procedure ordered.
  • Ensures appropriate medication hold orders have been addressed by referring physician
  • Clinical Knowledge
  • Demonstrates competence in patient/family education including, but not limited to, the types of bariatric procedures available, pre-operative preparation for surgery, post-operative signs, symptoms and treatment of, dietary limitations.
  • Assists in the facilitation of the bariatric support group
  • Assist in the scheduling of monthly support group. This includes the scheduling of rooms, seeking speakers, and providing communication to patient and family.
  • Provides yearly needs assessment to ensure programming meets the needs of the patients.
  • Monitors patient satisfaction on a monthly basis.
  • Participate in routine community educational seminars.
  • Attend and helps facilitate routine community educational seminars when needed.
  • Participates in task force on a quarterly basis.
  • Provide satisfaction numbers for both the program and support group. Takes responsibility for addressing areas of concern, which may include an action plan depending upon the issues.
  • Address any clinical issues that arise deviating a patient from following the standard patient pathway. This includes, but is not limited to, extended lengths of stay, inpatient and outpatient complications, and delays in service.
  • Works collaboratively with inpatient and outpatient departments to assist in addressing issues and developing a plan of action for improvement.
Essential Job Functions
  • Maintain professional and technical knowledge by attending education workshops, review professional publications, establish personal networks, and participate in professional societies.
  • Assure quality of care by adhering to therapeutic standards, measuring health outcomes against patient care goals and standards, making or recommending necessary adjustments, and following system/hospital and nursing division's philosophies and standards of care set by state board of nursing, state nurse practice act, and other governing agency regulations.
  • Protect patients and employees by adhering to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations.
  • Document patient care services by charting in patient and department records.
  • Maintain continuity among nursing teams by documenting and communicating actions, irregularities, and continuing needs using Nurse Knowledge Exchange techniques.
  • Maintain patient confidence and protects operations by keeping information confidential.
  • Identify patient care requirements by establishing personal rapport with potential and actual patients, and other persons in a position to understand care requirements.
  • Establish a compassionate environment by providing emotional, psychological, and spiritual support to patients, friends, and families.
  • Promote patient's independence by establishing patient care goals, teaching patient/family to understand condition, medications, and self-care skills, and answering questions.
  • Maintain safe and clean working environment by complying with procedures, rules and regulations; calling for assistance from health care support personnel.
  • Resolve patient problems and needs by utilizing multidisciplinary team strategies.
  • Maintain a cooperative relationship among health care teams by communicating information, responding to requests, building rapport, and participating in team continuous quality improvement and problem-solving methods.
  • Contribute to team effort by accomplishing related results as needed.
  • Ensure operation of equipment by completing preventive maintenance requirements by following manufacturer's instructions, troubleshooting malfunctions, calling for repairs, maintaining equipment inventories, and evaluating new equipment and techniques.
  • Maintain nursing supplies inventory by checking stock to determine inventory level, anticipating needed supplies, placing and expediting orders for supplies, verifying receipt of supplies, and using equipment and supplies as needed to accomplish job results.
  • The Registered Nurse may provide direct oversight of the GN, LPN, Technical Partner, ALS Technician, Nurse Extern and Unit Clerks. This oversight includes the Registered Nurse conducting the initial comprehensive assessment and interpreting the assessment to initiate the interprofessional plan of care. This oversight includes support of the delegation of duties that are within the scope and capability of the care team.
  • Other related duties as assigned.
Competency and Experience [Knowledge, Skills and Abilities]
Required Qualifications/Experience
  • Graduate of an accredited Nursing Program required.
  • One (1) year experience in Med/Surg nursing area.
  • Strong leadership ability, good organizational skills, independent and critical thinking skills, sound judgment, and knowledge of legal aspects and liability of nursing practice.
  • Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.
  • Ability to multi-task and prioritize assignments
  • A Nursing refresher course may be required if employee hasn’t worked in an acute care setting for his / her most recent three consecutive years of professional employment.
Preferred Qualifications/Experience
  • Bachelor’s Degree in Nursing preferred.
  • Previous experience in an outpatient office setting.
License, Certification & Clearances
  • Current licensure to practice as a Registered Nurse in the State of Pennsylvania required.
  • Current Basic Life Support (BLS) approved curriculum of the American Heart Association (CPR and AED) program required.
  • Act 33 with renewal.
  • Act 34 with renewal.
  • Act 73 FBI Clearance with renewal.

Supervisory Responsibilities
  • This position has no direct supervisory responsibilities, but may serve as a coach and mentor for other positions in the department.
Position Type/Expected Hours of Work
  • Incumbent will be scheduled based on operational need (rotate shifts, standby, on-call, etc.).
  • Travel may be expected locally between System locations.

Equal Employment Opportunity
Independence Health and its affiliated companies are Equal Opportunity Employers. It is their policy to prohibit discrimination of any type and to afford equal employment opportunities to employees and applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, disability, veteran status, or genetic information, or any other classification protected by law. Independence Health and its affiliated companies will comply with all applicable laws and regulations.
Disclaimer
This job description is not designed to contain a comprehensive listing of all activities, duties or responsibilities that are required of the employee. Moreover, duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Work Environment
When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.
Essential – Absolute Necessity.
Marginal – Minimal Necessity.
Constantly – 5.5 to 8 hours or more or 200 reps/shift.
Frequently – 2.5 to 5.5 hours or more or 32-200 reps/shift.
Occasionally – 0.25 to 2.5 hours or 2-32 reps/shift.
Rarely – Less than 0.25 hours or less than 2 reps/shift.
Physical Condition
Essential
Marginal
Constantly
Frequently
Occasionally
Rarely
Never
Extreme Heat
X
Extreme Cold
X
Heights
X
Confined Spaces
X
Extreme Noise(>85dB)
X
Mechanical Hazards
X
Use of Vibrating Tools
X
Operates Vehicle
X
Operates Heavy Equipment
X
Use of Lifting/Transfer Devices
X
X
Rotates All Shifts
X
X
8 Hours Shifts
X
X
10-12 Hours Shifts
X
X
On-Call
X
Overtime(+8/hrs/shift; 40/hrs/wk)
X
X
Travel Between Sites
X
X
Direct Patient Care
X
X
Respirator Protective Equipment
X
X
Eye Protection
X
X
Head Protection (hard hat)
X
Hearing Protection
X
Hand Protection
X
X
Feet, Toe Protection
X
Body Protection
X
X
Latex Exposur

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