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Prior Authorizations Nurse Jobs (NOW HIRING)

Equitas Health

Prior Authorization Specialist

Columbus, OH · On-site

$18.13 - $21.78/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Provide data on prior authorizations as needed to Senior Leadership. * Other duties as assigned by the Prior Authorization Supervisor, Director of Nursing, and Leadership. * Comply with the Equitas ...

Equitas Health

Prior Authorization Specialist

Columbus, OH · On-site

$18.13 - $21.78/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Provide data on prior authorizations as needed to Senior Leadership. * Other duties as assigned by the Prior Authorization Supervisor, Director of Nursing, and Leadership. * Comply with the Equitas ...

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Prior Authorizations Nurse information

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How much do prior authorizations nurse jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for prior authorizations nurse in the United States is $38.62, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $43.27 per hour, depending on experience, location, and employer.

What is the difference between Prior Authorizations Nurse vs Utilization Review Nurse?

AspectPrior Authorizations NurseUtilization Review Nurse
CredentialsRN license, possibly certifications in case managementRN license, certifications in case management or utilization review
Work EnvironmentHealthcare facilities, insurance companies, or outpatient settingsHospitals, insurance companies, or healthcare organizations
Job FocusSecuring prior approvals for treatments or proceduresAssessing medical necessity and reviewing patient cases for ongoing care
Common UsageUsed in insurance and healthcare to obtain treatment approvalUsed in case management and quality assurance to evaluate care appropriateness

The main difference is that a Prior Authorizations Nurse primarily focuses on obtaining approval for specific treatments or procedures before they are performed, while a Utilization Review Nurse evaluates ongoing patient cases to determine the necessity and appropriateness of continued care. Both roles require RN licensure and related certifications, but their daily tasks and focus areas differ within the healthcare and insurance industries.

What are some common challenges faced by prior authorizations nurses, and how can they be addressed?

Prior Authorizations Nurses often encounter challenges such as navigating complex insurance requirements, managing high volumes of authorization requests, and ensuring timely approval to avoid treatment delays. Staying organized and up-to-date on payer policies is crucial, as is effective communication with providers and insurance representatives. Building strong relationships with both clinical teams and payers can help streamline processes and reduce administrative burdens, ultimately improving patient care outcomes.

What are the key skills and qualifications needed to thrive as a prior authorizations nurse?

To thrive as a Prior Authorizations Nurse, you need a valid RN or LPN license, a strong understanding of insurance guidelines, and expertise in clinical documentation. Familiarity with prior authorization software, electronic health records (EHRs), and payer-specific systems is typically required. Attention to detail, strong communication skills, and the ability to multitask efficiently help nurses excel in reviewing medical necessity and advocating for patients. These skills are crucial to ensure timely approvals, minimize delays in patient care, and maintain compliance with regulatory and insurance requirements.

What is a prior authorizations nurse?

Prior Authorizations Nurses are registered nurses who specialize in reviewing and processing requests for medical procedures, treatments, or medications to ensure they meet insurance coverage guidelines. They assess clinical documentation, communicate with healthcare providers, and submit necessary paperwork to insurance companies for approval. This role helps ensure that patients receive timely care while complying with payer requirements, reducing delays in treatment and managing healthcare costs.
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What cities are hiring for Prior Authorizations Nurse jobs? Cities with the most Prior Authorizations Nurse job openings:
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Prior Authorizations Nurse jobs near you
Infographic showing various Prior Authorizations Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Referral Coordinator/Prior Authorizations

High Country Community Health

Mount Airy, NC

$16 - $18/hr

Full-time

Posted 14 days ago

Job description

Description

Job Summary and Responsibilities


The referral coordinator is responsible for implementing, monitoring, and tracking of all aspects of the clinic referral processes. Prior authorizations are tasks within the medical field that are required to provide medications, medical equipment, and diagnostic imaging. Responsibilities for both aspects of this position are listed below.


Referral Coordinator duties include:

Coordination and tracking of all clinical referrals utilizing the electronic health record.

Tracking and reporting on all appropriate Patient Centered Medical Home (PCMH) standards as directed. This specifically includes the elements related to tracking referrals, and transition of care.

Work with designated staff on appropriate clinic related referral processes

Collaborate with patient and consulting providers to complete referral process

Provides the highest level of customer service to internal and external clients.

Other duties as assigned

Prior Authorization duties include:

Responsible for all aspects of the prior authorization process

Collecting all the necessary documentation

Contacting the patient for additional information to ensure completion of the required prior authorization for the prescribed medication, medical equipment and diagnostic imaging

Interacts with patients, and insurance companies as necessary, to request prior authorizations.

Provides the highest level of customer service to internal and external clients.

Other duties as assigned

Requirements

Requirements/Qualifications/Skills/Experience

Minimum of at least 2 years in primary medical care setting. At least 1 year of experience with referrals preferred. Medical certification or licensure such as CMA, LPN, or RN preferred. Proficiency with electronic health records.

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