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Prior Authorization Rn Jobs (NOW HIRING)

Sluhn

Medication Prior Authorization Specialist

Allentown, PA · On-site

$17.75 - $23.75/hr

... nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Medication Prior Authorization Specialist ...

Varite

Licensed Practical Nurse - Prior Authorization

$26.25 - $35.75/hr

Review criteria-based prior authorizations following policy and procedure. * Provide on-call after hours nurse availability for urgent PA requests. * Provide internal nurse support to the PA team and ...

Pharmacy Careers

Remote Prior Authorization Pharmacist

$59.50 - $71.75/hr

Collaborate with physicians, nurses, and medical directors on complex cases. * Document outcomes in ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...

Pharmacy Careers

Remote Prior Authorization Pharmacist

$59.50 - $71.75/hr

Collaborate with physicians, nurses, and medical directors on complex cases. * Document outcomes in ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...

Pharmacy Careers

Remote Prior Authorization Pharmacist

$59.50 - $71.75/hr

Collaborate with physicians, nurses, and medical directors on complex cases. * Document outcomes in ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...

Pharmacy Careers

Remote Prior Authorization Pharmacist

$59.50 - $71.75/hr

Collaborate with physicians, nurses, and medical directors on complex cases. * Document outcomes in ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...

Pharmacy Careers

Remote Prior Authorization Pharmacist

$59.50 - $71.75/hr

Collaborate with physicians, nurses, and medical directors on complex cases. * Document outcomes in ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...

Pharmacy Careers

Remote Prior Authorization Pharmacist

$59.50 - $71.75/hr

Collaborate with physicians, nurses, and medical directors on complex cases. * Document outcomes in ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...

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Prior Authorization Rn information

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How much do prior authorization rn jobs pay per hour?

As of Jul 14, 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 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
Infographic showing various Prior Authorization Rn job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 88% Full Time, 10% Part Time, and 1% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,868 per year, or $42.2 per hour.

Medication Prior Authorization Specialist

Sluhn

Allentown, PA • On-site

$17.75 - $23.75/hr

Full-time

Posted 13 days ago

Job description

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.The Medication Prior Authorization Specialist is responsible for the coordination of insurance prior authorizations for applicable patient prescriptions. This role liaises with providers, insurance companies, and patients to perform insurance verification, obtain prior authorizations, and bring the authorization process to resolution.

JOB DUTIES AND RESPONSIBILITIES:

  • Monitors prior authorization work queues WQ(s) and promptly obtains and/or reviews patient insurance information and eligibility verification required to secure medication prior authorizations.
  • Utilizes online, fax, and telephony pathways to obtain prior authorizations from insurance companies for prescribed medications and documents medication prior authorizations in the medical record as necessary.
  • Seeks additional information and/or communicates updates to patients and providers as appropriate throughout the prior authorization process.
  • Engages insurance company representatives and provides required clinical information to secure prior authorization, when necessary.
  • Engages practice operations and incorporates clinical care team when prior authorization attempt is unsuccessful and/or a peer-to-peer and/or alternative medication is required.
  • Escalates complex prior authorization issues to Supervisor, Medication Prior Authorization for assistance/guidance.
  • Maintains working knowledge of St. Luke's electronic medical record system, internal systems and tools, and other online insurance websites.
  • Maintains solution-oriented/creative mindset to effectively anticipate and tend to patient needs by partnering with other organizational team members/departments.
  • Actively participates in performance improvement and continuous quality improvement activities.
  • Other related duties as assigned.

PHYSICAL AND SENSORY REQUIREMENTS:

Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephones, data entry, etc. Occasional twisting and turning. Uses upper extremities to lift and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve files. Hearing as it relates to normal conversation. Seeing as it relates to general vision. Visual monotony when reading reports and reviewing computer screen.

EDUCATION:

  • High School graduate or equivalent.

TRAINING AND EXPERIENCE:

Required:

  • One year practice-based experience or in a similar healthcare setting.

Preferred:

  • Customer service experience.
  • Previous prior authorization experience.
  • Previous Medical Assistant experience.

Please complete your application using your full legal name andcurrent home address. Be sure toincludeemployment history forthe past seven (7) years, including your present employer. Additionally, you areencouraged to upload a current resume, including all work history, education, and/or certifications andlicenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

St. Luke's University Health Network is an Equal Opportunity Employer.

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