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Remote Prior Authorization Nurse Jobs in Racine, WI

Adecco

Pharmacist Pipeline Milwaukee WI

Milwaukee, WI · On-site +1

$58 - $60.75/hr

Adecco Healthcare & Life Sciences is hiring remote pharmacists! For this role you must reside ... reviewing prior authorizations and receiving phone calls from prior authorization pharmacy ...

DRUM Associates

Be Seen First

Customer Service Representative

Milwaukee, WI · Remote

$24/hr

Knowledge of Medicare, Medicaid, insurance verification, prior authorizations, or healthcare documentation workflows Work Environment * Remote - but must be location in Wisconsin or Minnesota

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Remote Prior Authorization Nurse information

See Racine, WI salary details

$16

$36

$61

How much do remote prior authorization nurse jobs pay per hour?

As of Jul 26, 2026, the average hourly pay for remote prior authorization nurse in Racine, WI is $36.21, according to ZipRecruiter salary data. Most workers in this role earn between $27.74 and $40.58 per hour, depending on experience, location, and employer.

What is a Remote Prior Authorization Nurse job?

A Remote Prior Authorization Nurse is a registered nurse (RN) or licensed practical nurse (LPN) who reviews medical insurance requests to determine if they meet coverage criteria. They work remotely to assess patient records, collaborate with healthcare providers, and communicate approval or denial decisions based on insurance guidelines. Their role helps ensure patients receive necessary treatments while managing costs for insurance companies. Strong clinical knowledge, attention to detail, and familiarity with insurance policies are essential for this position.

What are the key skills and qualifications needed to thrive in the Remote Prior Authorization Nurse position, and why are they important?

To thrive as a Remote Prior Authorization Nurse, you need a current RN license, knowledge of medical terminology, and experience with insurance or utilization review processes. Familiarity with prior authorization software, electronic medical records (EMRs), and payer systems is typically required, along with certifications like CCM or CPUR as a plus. Strong attention to detail, organizational skills, and effective written communication are valuable soft skills for this role. These skills are crucial to ensure accurate and efficient authorization of healthcare services, reduce claim denials, and facilitate patient care in a remote setting.

What does a typical day look like for a Remote Prior Authorization Nurse?

A typical day for a Remote Prior Authorization Nurse involves reviewing medical records and provider documentation, communicating with physicians or healthcare providers to gather additional information, and submitting authorizations to insurance companies. You may spend much of your time using specialized software to track requests, document outcomes, and ensure compliance with payer guidelines. Collaboration is often required with case managers, providers, and insurance representatives to resolve questions and expedite approvals. While the work is primarily independent, staying organized and communicating effectively with the healthcare team are essential for success in this remote position.

What are popular job titles related to Remote Prior Authorization Nurse jobs in Racine, WI? For Remote Prior Authorization Nurse jobs in Racine, WI, the most frequently searched job titles are:
What job categories do people searching Remote Prior Authorization Nurse jobs in Racine, WI look for? The top searched job categories for Remote Prior Authorization Nurse jobs in Racine, WI are:
What cities near Racine, WI are hiring for Remote Prior Authorization Nurse jobs? Cities near Racine, WI with the most Remote Prior Authorization Nurse job openings:
Remote Prior Authorization Nurse jobs near you
Infographic showing various Remote Prior Authorization Nurse job openings in Racine, WI as of July 2026, with employment types broken down into 69% Full Time, 23% Part Time, and 8% Contract. Highlights an 100% Remote job distribution, with an average salary of $75,315 per year, or $36.2 per hour.
Prior Authorization/Referral Specialist

Prior Authorization/Referral Specialist

Froedtert South, Inc.

Pleasant Prairie, WI • On-site, Remote

$17 - $25.25/hr

Part-time

Medical, Dental, Vision, Retirement, PTO

Posted 14 days ago

Froedtert South rating

6.9

Company rating: 6.9 out of 10

Based on 39 frontline employees who took The Breakroom Quiz

454th of 890 rated healthcare providers

Job description

  • POSITION PURPOSE
    • The Prior-Authorization/Referral Specialist plays a key role in supporting patient access to care by verifying insurance eligibility and benefits, and securing required pre-certifications, authorizations, and referrals for both facility and professional services. This position ensures timely and accurate communication with payors and healthcare providers, obtains necessary clinical documentation to support medical necessity, and maintains detailed records throughout the authorization process.
  • MINIMUM EDUCATION REQUIRED
    • High School or GED
  • MINIMUM EXPERIENCE REQUIRED
    • One (1) year of insurance/prior authorization experience (preferred)
    • Experience and familiarity with using insurance portals
  • LICENSES / CERTIFICATIONS REQUIRED
    • None
  • KNOWLEDGE, SKILLS & ABILITIES REQUIRED
    • Strong customer service orientation with excellent interpersonal and computer skills.
    • Working knowledge of medical terminology and healthcare documentation standards.
    • Demonstrated ability to manage time effectively, prioritize tasks, and maintain accuracy in a high-volume environment.
    • Proficient with internet-based tools, email communication, and Microsoft Office applications (e.g., Word, Excel, Outlook).
    • Strong written and verbal communication skills, with the ability to interact professionally with patients, clinicians, and insurance representatives.
    • Proven experience in prior authorizations, referrals, patient registration, insurance verification, and understanding of various health insurance plans (preferred).
    • Proficient in navigating online prior authorization portals and working with multiple commercial and government payors (preferred).
    • Knowledge of medical coding systems, including ICD-10, CPT, and HCPCS codes (preferred).
  • PRINCIPLE ACCOUNTABILITIES AND ESSENTIAL DUTIES
    • Verify insurance eligibility and benefits for scheduled services to determine prior-authorization or referral requirements.
    • Initiate and follow through on prior-authorization and referral requests with payors, ensuring timely approvals.
    • Collect and submit required clinical documentation to support medical necessity and facilitate authorization.
    • Document all authorization activities accurately in the electronic health record (EHR) and/or designated tracking systems.
    • Communicate authorization status and requirements clearly to providers, clinical staff, and patients as needed.
    • Coordinate with providers and clinical teams to obtain additional information or clarification required by payors.
    • Maintain up-to-date knowledge of payer policies, coding guidelines (ICD-10, CPT, HCPCS), and authorization processes.
    • Ensure timely resolution of authorization-related issues to prevent delays or denials in patient care or billing.
    • Provide exceptional customer service when interacting with internal teams, external payors, and patients.
    • Participate in continuous quality improvement efforts, including audits, training, and performance reviews.
       
      Salary Range: $17.00 to $25.25/hr (based on experience)
       

      Benefits:

      • Medical, dental and vision benefits available
      • 403(b) company match available
      • Tuition reimbursement
      • Employee discount program
      • Competitive PTO

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