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

Anthony L. Jordan Health

MAAT CLINIC RN

Rochester, NY · On-site

$73K - $77K/yr

... prior authorizations for MAAT related medications and facilitate the coordination of MAAT related medications in terms of following up on prescriptions, prior authorizations, ensuring safe ...

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 ...

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

Prior Authorization Rn information

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$7

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How much do prior authorization rn jobs pay per hour?

As of Jul 15, 2026, the average hourly pay for prior authorization rn in Rochester, NY is $41.58, according to ZipRecruiter salary data. Most workers in this role earn between $31.01 and $49.23 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?

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.

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.
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Prior Authorization Rn jobs near you
Medication Authorization Specialist

Medication Authorization Specialist

Rochester Regional Health

Rochester, NY • On-site

$18 - $25/hr

Part-time

Re-posted 13 days ago

Rochester Regional Health rating

7.4

Company rating: 7.4 out of 10

Based on 216 frontline employees who took The Breakroom Quiz

265th of 885 rated healthcare providers

Job description

  • Job Title: Medication Authorization Specialist
    Location: Rochester General MOB (1415 Portland Avenue, Rochester, NY 14621)
    Department: Pharmacy
    Hours Per Week: 20 Hours, Part-time
    Schedule: Monday, Tuesday and Thursday 8a-4p or 8:30a-5p
    Key Responsibilities:
    • Coordinate and submit medication prior authorization requests to insurance companies, ensuring timely approvals.
    • Monitor, track, and follow up on prior authorizations, step therapy requirements, and appeals processes.
    • Communicate with providers to obtain necessary clinical documentation for insurance submissions.
    • Assist patients in applying for pharmaceutical assistance foundation programs, grants, and/or co pay programs
    • Maintain up-to-date knowledge of manufacturer support programs and eligibility requirements.
    • Track patient enrollment status and renewal needs for financial programs.
    • Contact patients to explain coverage decisions, out-of-pocket costs, and available financial options.
    • Provide empathetic, patient-centered support to help navigate financial barriers to care.
    • Serve as a key point of contact for patients regarding their cardiology medication access issues.
    • Document all activities accurately and timely in the Electronic Health Records (EHR)
    • Work collaboratively with physicians, nurses, pharmacists, and administrative staff to streamline access workflows.
    • Participate in process improvement initiatives to enhance patient experience and medication access efficiency.
    • All other duties as assigned.

    Preferred Qualifications:
    • Associates Degree in healthcare administration or business preferred.
    • Experience with prior authorizations, pharmacy or specialty medications preferred.
    • Proficiency in electronic medical records (EMR) systems and Microsoft Office applications.
    • Excellent communication skills including both oral and written as well as interpersonal skills.
    • Ability to handle simultaneous tasks paying great attention to detail.
    • Flexibility and ability to work as a team player.
    • Understanding of managed care, formularies, and payer policies.
    • Experience with Electronic Health Records (EHR) systems.
    • Strong verbal and written skills for interacting with providers, patients, and insurers.
    • Ability to pay attention to detail and ability to manage high volumes of requests with accuracy.

    Minimum Qualifications:
    • 2 years work experience in a healthcare settings, medical billing, pharmacy, or insurance verification.

    Required Licensure/Certification:
    • N/A

EDUCATION:
LICENSES / CERTIFICATIONS:
PHYSICAL REQUIREMENTS:
M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.
PAY RANGE:
$18.00 - $25.00
CITY:
Rochester
POSTAL CODE:
14621
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.
Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.

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