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Prior Authorization Rn Jobs in Pomona, CA (NOW HIRING)

Leeds Nursing Services

RN/LPN -- General

Pasadena, CA · On-site

$60 - $85/hr

General Qualifications for Registered Nurse (RN) and Licensed Practical Nurse (LPN) in California ... Legal authorization to work in the United States. Personal Attributes Compassionate and ...

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All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Pomona, CA

Prior Authorization Rn information

See Pomona, CA salary details

$7

$42

$72

How much do prior authorization rn jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for prior authorization rn in Pomona, CA is $42.42, according to ZipRecruiter salary data. Most workers in this role earn between $31.63 and $50.19 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 Pomona, CA as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 18% Part Time, 1% Temporary, and 4% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $88,233 per year, or $42.4 per hour.

Patient Care Navigator

COPE Health Solutions

Los Angeles, CA

$25 - $29/hr

Full-time

Re-posted 20 days ago

Job description

The Care Navigator is a team member who supports the Care at Home Solutions team with administrative duties and facilitates patient continuity of care. Under the clinical direction and oversight of the Program Director and APP, the Care Navigator navigates patients at risk by collaborating with the patient, family, and members of the healthcare team to serve needs and expedite appropriate, cost-effective care. Working closely with the Medical Director, Advanced Practice Provider (APP), Registered Nurse (RN), Pharmacist, Community Health Workers (CHWs), and primary and specialty providers, the Patient Care Navigator helps patients navigate the healthcare system, access needed services and remain engaged in their care plans. This role supports Annual Wellness Visit (AWV) completion, chronic disease management, referral coordination, specialty access, and achievement of value-based care performance goals.

FLSA Status

Non-Exempt

Salary Range

$25.00-$29.00

Reports To

Administrator / Practice Manager

Direct Reports

None

Location

Hybrid; LA Office

Travel

Up to 30%

Work Type

Regular

Schedule

Full Time

Position Description:

  • Serves as a primary point of contact for patients, caregivers, and community partners.
  • Schedules telehealth and in-person appointments with physicians, APPs, pharmacists, specialists, and other care team members.
  • Conducts patient intake, registration, insurance verification, and demographic updates.
  • Coordinates referrals, specialty appointments, diagnostic testing, and follow-up services.
  • Assists with prior authorization requests and tracks authorization status.
  • Performs outreach to schedule Annual Wellness Visits (AWVs), preventive screenings, chronic care follow-up appointments, and quality gap closure initiatives.
  • Monitors appointment adherence and conducts outreach to reduce no-shows and missed visits.
  • Supports patient onboarding and education regarding telehealth technology and practice workflows.
  • Coordinates communication among providers, Community Health Workers, pharmacists, nurses, and external healthcare organizations.
  • Receives patient inquiries and escalates clinical concerns to licensed clinical staff in accordance with organizational protocols.
  • Supports care transitions following hospitalizations, emergency department visits, and specialty care encounters.
  • Maintains accurate and timely documentation within the Electronic Medical Record (EMR) and other designated systems.
  • Participates in interdisciplinary care team meetings and population health initiatives.
  • Supports achievement of organizational goals related to access, patient experience, quality performance, and value-based care outcomes.

Qualifications

  • High school diploma or equivalent required.
  • Associate degree or healthcare-related certification preferred.
  • Minimum two (2) years of experience in a medical office, physician practice, care coordination, scheduling, referral management, or healthcare customer service role preferred.
  • Experience supporting Medicare Advantage, managed care, primary care, or value-based care programs preferred.
  • Experience with referral management, prior authorizations, and appointment scheduling preferred.
  • Experience using Electronic Medical Record (EMR) systems required.
  • Bilingual English/Spanish preferred.

Working Knowledge of the Following Required

  • Medical office operations and patient scheduling workflows.
  • Medicare Advantage and commercial payer programs.
  • Referral management and prior authorization processes.
  • Customer service and patient engagement principles.
  • Telehealth care delivery models.
  • Electronic Medical Record (EMR) systems and healthcare technology platforms.

Examples of Competencies

  • Strong customer service and patient engagement skills.
  • Excellent organizational and follow-up abilities.
  • Ability to manage multiple priorities in a fast-paced healthcare environment.
  • Strong communication and interpersonal skills.
  • Attention to detail and documentation accuracy.
  • Ability to work collaboratively within interdisciplinary care teams.
  • Professionalism, accountability, and problem-solving capabilities.
  • Commitment to patient-centered service and operational excellence.

Benefits:

As a firm passionate about health care, we're deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities, and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/why-cope-health-solutions/.

About COPE Health Solutions
COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit CopeHealthSolutions.com.

To Apply:

To apply for this position, or to view all available positions, visit us at https://copehealthsolutions.com/careers/open-positions/.

Employment Type: Intern Full Time

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