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Prior Authorizations Nurse Jobs (NOW HIRING)

WomanCare Centers

Prior Authorization Nurse

Norfolk, VA · On-site

$25 - $31/hr

Manage medication prior authorizations as the primary responsibility of the position, including ... Minimum of 2 years of nursing experience in Prior Authorizations. * Strong clinical assessment ...

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How much do prior authorizations nurse jobs pay per hour?

As of Aug 26, 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 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.

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 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 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.

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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, 80% Full Time, 16% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Prior Authorization Nurse

Norfolk, VA • On-site

WomanCare Center, PLC
See more jobs at WomanCare Center, PLCexternal

Other

PTO

Posted 7 days ago

Job description

WomanCare Centers Prior Authorization Nurse

We are a busy, patient-centered OB/GYN outpatient practice dedicated to providing compassionate, comprehensive care to women at every stage of life. Our team values communication, collaboration, and continuity of care—both in and out of the office. We're seeking an experienced Medication Prior Authorization Nurse to join our dynamic team in an in-person, non-remote position. The primary focus of this role is the timely and accurate management of medication prior authorizations, working closely with providers, pharmacies, insurance companies, and patients to facilitate access to prescribed medications.

Responsibilities:
  • Manage medication prior authorizations as the primary responsibility of the position, including initiating, completing, submitting, and tracking prior authorization requests.
  • Review medication orders and insurance requirements to determine appropriate prior authorization processes and required documentation.
  • Gather and submit supporting clinical documentation, including diagnoses, treatment history, laboratory results, and other information required for authorization.
  • Monitor pending prior authorizations and proactively follow up to ensure timely resolution and minimize delays in patient treatment.
  • Assist with appeals, reconsiderations, peer-to-peer requests, and alternative medication options when prior authorization requests are denied, as directed by the provider.
  • Maintain accurate and timely documentation of all prior authorization activities in the electronic health record (EHR).
  • Process medication refill requests as appropriate, ensuring clinical appropriateness and adherence to established protocols.
  • Stay current with payer requirements, medication authorization processes, and changes that may affect patient access to medications.
  • Other duties as assigned.
Qualifications Desired
  • Minimum of 2 years of nursing experience in Prior Authorizations.
  • Strong clinical assessment, critical thinking, and problem-solving skills.
  • Excellent communication, organization, documentation, and time-management skills.
  • Strong attention to detail and ability to manage multiple prior authorizations and follow-up tasks simultaneously.
  • Ability to work independently while collaborating effectively with providers, pharmacies, insurance companies, and members of the care team.
  • Compassionate, patient-centered approach to care.
  • Ability to work in person; this position is not eligible for remote work.
  • Familiarity with medication formularies.
  • Knowledge of common OB/GYN conditions, including prenatal care, contraception, menstrual issues, menopause, infections, and pregnancy complications.
Why Join Our Team?
  • Paid time off that increases with tenure.
  • Major federally recognized holidays off with pay.
  • Competitive benefits package with optional supplemental benefits.
  • Leadership dedicated to cultivating and maintaining a positive environment that encourages professional growth.
  • Opportunities to take on healthy challenges and develop your clinical and administrative skills.
  • A collaborative team environment with coworkers who encourage and support one another in achieving success.

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