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Prior Authorization Rn Jobs (NOW HIRING)

W3R

RN Prior Authorization

Austin, TX

The Registered Nurse conducts pre-service, concurrent/ retrospective reviews. * They will collaborate with healthcare providers to promote quality member outcomes, to optimize member benefits, and to ...

Arizona Priority Care

Prior Cert RN Manager

Chandler, AZ · Hybrid

$96K - $100K/yr

As the Pre Cert RN Manager, you will lead a high-performing team focused on ensuring timely ... Lead and support the Prior Authorization Supervisor and nursing staff to ensure effective daily ...

Regal Medical Group, Inc.

Position Summary: The role of the Director, Prior Authorization is to oversee the prior ... RN license.

Regal Medical Group, Inc.

$45 - $50/hr

The role of the Prior Authorization Review Nurse, LVN/RN is to promote the quality and cost effectiveness of medical care by applying clinical judgement and the appropriate application of policies ...

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How much do prior authorization rn jobs pay per hour?

As of May 30, 2026, the average hourly pay for prior authorization rn in the United States is $42.24, according to ZipRecruiter salary data. Most workers in this role earn between $31.49 and $50.00 per hour, depending on experience, location, and employer.

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 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 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 the United States as of May 2026, with employment types broken down into 2% As Needed, 40% Full Time, 51% Part Time, and 7% Contract. Highlights an 96% Physical, 2% Hybrid, and 2% Remote job distribution, with an average salary of $87,868 per year, or $42.2 per hour.

Prior Authorization Temp Nurse Case Manager

Care Navigators On Demand

Northridge, CA • On-site

$38 - $42/hr

Temporary

Posted 19 days ago

Job description

Job Description
Prior Authorization Temp Nurse Case Manager, RN
Northridge, CA
4-Month Contract Assignment
  • Quick On-Boarding/Placement Process
  • Career Stepping Stone from Bedside Nursing to Case Management (acute care experience and working knowledge of pre-auth process required)

Description
The role of the Prior Authorization Nurse Case Manager (PACM) is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization specialty referral requests. The PACM will review for appropriate care and setting, and following guidelines/policies, will approve services when indicated. If not indicated, PACM will forward requests to the appropriate physician or medical director with recommendations for other determinations, ensuring that the member is receiving the appropriate quality care in a preferred setting, while making sure regulatory guidelines are followed.
1. Understand, promote and review with the principles of medical management to facilitate the right care at the right time in the right setting.
2. Communicate effectively and interact with providers, staff and health plans daily regarding medical management and referral authorization issues.
3. Maintain a working relationship with PACM colleagues, the pre-auth coordinator team, high-risk nurse case managers, inpatient nurse case managers, medical directors, and network management.
4. Research alternative care plans and when necessary, assist in the routing of members to the most appropriate care/setting, in order to provide right care/right setting.
5. When necessary, act as liaison between the case managers, UM coordinators, contracted providers (PCPs/specialists/ancillary), and the members/families.
6. Perform case reviews base on key screening outpatient indicators, and evaluate the PCP submitted plan of care for its completeness of documentation, consistency of treatment with medical groups clinical practice guidelines, adherence to standard evidence-based or consensus guidelines, and health plan and CMS guidelines and/or medical policies.
7. Maintain regulatory Turnaround Time Standards per regulatory guidelines.
8. Document accurately and completely all necessary information in authorization notes.
9. Understand all applicable capitation contracts and how they apply to review duties.
10. For those PACMs involved in DME, understand the contracts, and need to review rental vs. purchase approvals, and continued use so that equipment is picked up when needed.
11. When appropriate, coordinate and review for medical necessity and appropriate utilization any ancillary professional services, i.e. (home health, infusion, PT, OT, ST, etc.).
12. Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
13. Participates in "service recovery" through follow-up with an upset patient or provider, gathering information, and demonstrating empathy.
14. Identifies network needs and report to management for potential contracting opportunities.
Qualifications
1.Graduate from an accredited Registered Nursing Program
2.Current California RN License
3.Minimum of 1 year acute experience
4.Knowledge of Managed Care preferred.
5.Knowledge of NCQA, CMS, HSAG, and health plan requirements related to utilization management.
6.Knowledgeable with the pre-authorization process and workflow, with prior authorization experience preferred.
7.Knowledgeable in computers and MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
8.Ability to deal with responsibility with confidential matters
9.Ability to work in a multi-tasking, fast-paced, high-stress environment.
Compensation
$38-$42/Hr
Negotiable based on experience

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