ZipRecruiter

Log In

1

Prior Authorization Rn Jobs in Rochester, NY (NOW HIRING)

Villa of Hope

Clinic RN

Rochester, NY · On-site

JOB TITLE: Part Time Clinic Registered Nurse DEPARTMENT/PROGRAM: BHS Clinics SUPERVISOR: Nurse ... Prior Authorizations: Initial request through completion * Administration and documentation of ...

next page

Showing results 1-20

People also search for

All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Rochester, NY

Prior Authorization Rn information

See Rochester, NY salary details

$7

$41

$71

How much do prior authorization rn jobs pay per hour?

As of Jun 18, 2026, the average hourly pay for prior authorization rn in Rochester, NY is $41.68, according to ZipRecruiter salary data. Most workers in this role earn between $31.06 and $49.33 per hour, depending on experience, location, and employer.

How to make $300,000 a year as a nurse?

A Prior Authorization RN can earn $300,000 annually by gaining extensive experience, obtaining advanced certifications, and working in high-paying settings such as specialty clinics or insurance companies. Increasing workload, taking on leadership roles, or working overtime can also boost income, but reaching this level typically requires a combination of expertise, efficiency, and strategic employment choices.

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?

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.

Can nurses do prior authorizations?

Prior authorization nurses, often called utilization review nurses or case managers, are qualified to handle prior authorization requests. They review medical documentation, communicate with providers and insurance companies, and ensure compliance with payer requirements, often using electronic health record systems. Certification in case management or utilization review can enhance their ability to perform these tasks effectively.

How to make an extra 2000 a month as a nurse?

A Prior Authorization RN can increase income by taking on additional shifts, working overtime, or offering consulting services to healthcare providers. Developing specialized knowledge in insurance authorization processes and obtaining relevant certifications can also lead to higher-paying opportunities or freelance work 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 Rochester, NY? For Prior Authorization Rn jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Rn jobs in Rochester, NY look for? The top searched job categories for Prior Authorization Rn jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Prior Authorization Rn jobs? Cities near Rochester, NY with the most Prior Authorization Rn job openings:
Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in Rochester, NY as of June 2026, with employment types broken down into 2% As Needed, 60% Full Time, 22% Part Time, 14% Contract, and 2% Summer. Highlights an 94% In-person, 2% Hybrid, and 4% Remote job distribution, with an average salary of $86,696 per year, or $41.7 per hour.
Pharmacy Prior Authorization Technician

Pharmacy Prior Authorization Technician

w3r Consulting

Rochester, NY • On-site

$17.25 - $21/hr

Contractor

Medical

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Summary Description:
The Pharmacy Prior Authorization Technician performs functions as permitted by law including the initial level processing and review of prior authorization requests for both pharmacy reviews and medical specialty drug reviews. These reviews are performed utilizing pharmacy management drug policies and procedures. This position accurately prepares and interprets cases for UM (utilization management) reviews and determination. In addition, the Technician is the content expert for the applications used to process these requests. The Technician acts as a resource for staff regarding members' specific contract benefits, consistent with products, policies and procedures and related health plan functions such as member services, claims, and the referral/authorization process. This position provides leadership and expertise in the intake area of the prior authorization process for medications processed either through the pharmacy or medical benefit and in processing exception/prior authorization requests that follow standard protocols.
Essential Responsibilities/Accountabilities:
Level I:
• Conducts an initial level medication prior-authorization, exception and medical necessity reviews submitted to the plan to determine coverage under the member's benefit.
• Routes cases directly to the pharmacist/medical director for final determination, as directed.
• Issues verbal and written member notification as required.
• Reviews and interprets prescription and medical benefit coverage across all lines of business including Medicare D to determine what type of prior authorization review is required, documents any relevant medication history and missing information to assist the pharmacist/nurse/physician in the review process.
• Develops and implements process improvement to increase efficiency in the review process for the clinical staff.
• Works with requesting providers, clinical pharmacists, and other internal staff, as appropriate, in determining whether specific case presentation meets the criteria for approval according to the medical or prescription drug policy and specific coverage criteria.
• Can point out nuances that may not be readily apparent regarding the request.
• Contacts pharmacies and physician offices as necessary to obtain clarification on prior authorization requests and drugs being billed through the point-of-sale system and/or medical claim system in order to optimize the member experience.
• Acts as a lead troubleshooter for the pharmacy help desk, customer care and claim processors to coordinate pharmacy and/or medical claims with prior authorization information on file or needed for the member.
• Responsible for assuring appropriate auth entry across all lines of business. Ensure care management system interfaces to claim processing system for claim payment. Manual manipulation of auth may be required upon case completion.
• Performs system testing as required for upgrades and enhancements to the care management system.
• Acts as a content expert for prior authorization intake for our customers, both internal and external. Serves as department subject matter expert for pharmacy and medical drug authorizations and coverage.
• Serves as lead liaison for the prior authorization process and its interface to the pharmacy and medical claim systems to troubleshoot. Triages issues to the appropriate department for resolution.
• Triages prior authorization workflow daily by rerouting cases, alerting clinical staff of time frame deadlines, monitoring work queues and keeping management aware of issues related to compliance mandated time frames for review completion.
• Provides phone coverage for incoming calls as required to support the UM process. This may include authorization inquiries and information requests, claim inquiries, and other related inquiries. Provides friendly, accurate and timely assistance.
• Supports medical and pharmacy drug pricing questions, and uses drug lookup tools such as government sites, and other online resources.
• Maintains thorough knowledge and understanding of sources of information about health plan contracts, riders, policy statements, and procedures to identify eligibility and coverage and assisting other staff with related inquiries.
• Performs unit specific workflow processes consistent with corporate medical & administrative policies, employer specific guidelines, and/or regulatory agencies.
• Produces, records, or distributes information for others. On a periodic basis, tracks and reports department performance against benchmarks.
• Prepares and assists in handling correspondence. Assures accuracy and timeliness of processing.
• Participates in interdepartmental coordination and communication to ensure delivery of consistent and quality health care services examples include Utilization Management, Quality Management and Case Management.
• Produces, at minimum, the team average medication prior-authorization, exception and medical necessity reviews submitted to the plan to determine coverage under the member's benefit.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
Minimum Resource Qualifications:
All Levels:
• High school diploma with a minimum of two years' experience in health-related field is required. Associates degree preferred.
• Pharmacy Technician certification (CPhT), LPN, Medical Assistant/Technologist background strongly preferred.
Physical Requirements:
• Ability to work prolonged periods sitting at a workstation and working on a computer.
• Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Typical office environment including fluorescent lighting.
• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• The ability to hear, understand and speak clearly while using a phone, with or without a headset.

Apply