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Prior Authorization Rn Jobs in Springfield, MA (NOW HIRING)

Valley Health Systems

LPN /RN

Holyoke, MA · On-site

$34.33 - $53.81/hr

$5,000 SIGN-ON BONUS FOR FULL-TIME RN & LPN's WITH AT LEAST TWO YEARS OF EXPERIENCE AS AN RN or LPN ... Manage Prior Authorization, Med Refills, Triage Call and voicemails * Conduct ambulatory nurse ...

Valley Health Systems

LPN /RN

Holyoke, MA · On-site

$34.33 - $53.81/hr

$5,000 SIGN-ON BONUS FOR FULL-TIME RN & LPN's WITH AT LEAST TWO YEARS OF EXPERIENCE AS AN RN or LPN ... Manage Prior Authorization, Med Refills, Triage Call and voicemails * Conduct ambulatory nurse ...

Holyoke Hospital

Registered Nurse

Holyoke, MA · On-site

Registered Nurse $5,000 sign-on bonus for full-time RN with at least two years of experience as an ... prior authorizations, prescription refills, and adherence to clinical protocols Qualifications:

Valley Health Systems

Registered Nurse

Holyoke, MA

$34.33 - $53.81/hr

... * Assist in prior authorizations, prescription refills, and adherence to clinical protocols ... Current license as a Registered Nurse within the Commonwealth of Massachusetts; current CPR ...

Valley Health Systems

Registered Nurse

Holyoke, MA · On-site

$34.33 - $53.81/hr

... * Assist in prior authorizations, prescription refills, and adherence to clinical protocols ... Current license as a Registered Nurse within the Commonwealth of Massachusetts; current CPR ...

Valley Health Systems

Registered Nurse

Holyoke, MA

$34.33 - $53.81/hr

... prior authorizations, prescription refills, and adherence to clinical protocols Qualifications ... Current license as a Registered Nurse within the Commonwealth of Massachusetts; current CPR ...

Valley Health Systems

Registered Nurse

Holyoke, MA · On-site

$34.33 - $53.81/hr

... prior authorizations, prescription refills, and adherence to clinical protocols Qualifications ... Current license as a Registered Nurse within the Commonwealth of Massachusetts; current CPR ...

KMG Healthcare

Registered Nurse (RN)

Windsor Locks, CT · On-site

$60/hr

Administers medications and medical treatments competently as directed by a Physician Qualifications: * RNs with prior occupational health, ER or ambulatory care experience preferred. * Currently ...

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All JobsPrior Authorization Rn JobsPrior Authorization Rn Jobs in Springfield, MA

Prior Authorization Rn information

See Springfield, MA salary details

$7

$42

$71

How much do prior authorization rn jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for prior authorization rn in Springfield, MA is $42.10, according to ZipRecruiter salary data. Most workers in this role earn between $31.39 and $49.81 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 Springfield, MA as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $87,560 per year, or $42.1 per hour.

Prior Authorization Specialist - Radiology

Hartford, CT • On-site

Hartford HealthCare at Home
Health Care and Social Assistance • 201 - 500 employees
Learn more about Hartford HealthCare at Homeexternal

$18.25 - $24.25/hr

Other

Posted 12 days ago

Job description

Diagnostic Imaging Scheduler

Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. Hartford Hospital is one of the largest and most respected teaching hospitals New England. We are a Level 1 Trauma Center that provides cutting edge treatment to its patients. This is made possible by being home to the largest robotic surgery center in the Northeast and the Center for Education, Simulation and Innovation (CESI), one of the most-advanced medical simulation training centers in the world. When hospitals cannot provide the advanced care, expertise and new treatment options their patients require, they turn to us.

Job Responsibilities

Appropriately schedule and or reschedule departmental procedures according to specific modality protocols and patient care requirements, maintaining patient confidentiality in accordance with HIPAA guidelines. Ensures completion and accuracy of provider's order in relation to requested appointment type for compliance/medical necessity and communicates discrepancies to provider office. Register patient if required. Obtains all relevant patient information, including current lab values and medication usage, current history and physical, as well as other pertinent medical history, necessary for ensuring patient safety and to obtain accurate diagnosis. Obtains current, complete and accurate patient insurance information to ensure full reimbursement Communicate, educate and instruct patients on detailed procedural preparations, provide complete instructions on specific aspects of their procedure and post procedure instructions Provides office support to meet the unit needs. Function as a point person, interacting in a courteous manner with patients, patient families, providers, nurses, administrative staff internal and external to HHC in the coordination of patient care, such as but not limited to, answering question, triaging calls, obtaining patient transport, required equipment and supplies, patient referrals, resolving registration and billing issues., etc. Participates in Training/orienting/mentoring new employees as requested.

Qualifications

High School Diploma required, Associate's degree preferred. Two (2) years medical office experience, medical terminology Two years scheduling diagnostic imaging procedures preferred With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment. As an Equal Opportunity Employer/Affirmative Action employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status. Regular Standard Hours Per Week : 40 Schedule : Full-time (40 hours) Shift Details : M-F 8-4:30p

Hartford HealthCare at Home logo

About Hartford HealthCare at Home

Sourced by ZipRecruiter

Hartford HealthCare at Home, based in Wethersfield, Connecticut, US, is a premier provider in the healthcare industry, specifically in home-based care services. Their official website can be accessed at hartfordhealthcareathome.org. They offer a wide range of services including nursing, physical therapy, occupational therapy, speech therapy, social work, and home health aid. The company was established with the mission to enhance the capability of people to achieve optimal health and wellbeing through its home care services. They maintain a patient-centric approach and belief in making a real difference in people's lives. As an integral part of Hartford HealthCare, they share the vision to be “most trusted for personalized coordinated care”.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Wethersfield, CT, US

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