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Remote Prior Authorization Nurse Jobs in Renton, WA

Briljent

Clinical Domain Project Manager (PBM)

Seattle, WA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... prior authorization, utilization management, drug utilization review, clinical criteria ... This is a fully remote, full time engagement with an anticipated duration of ten months and an ...

Briljent

Clinical Domain Project Manager (PBM)

Seattle, WA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... prior authorization, utilization management, drug utilization review, clinical criteria ... This is a fully remote, full time engagement with an anticipated duration of ten months and an ...

PPGNHI

Clinical Director of Virtual Care Programs

Tacoma, WA · On-site +1

$85K - $117K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Hire, mentor, and manage remote care staff (APCs, RNs, case managers, patient navigators) and ... Prior Authorization Navigators, Gender Affirming Care Navigators, and Medical Records/Patient ...

Evergreen Health

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... prior authorization in a hospital, provider, or healthcare system. Healthcare medical billing and reimbursement Remote in Washington State only Posted wage ranges represent the entire range from ...

EvergreenHealth

Denial Management Specialist

Kirkland, WA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... prior authorization in a hospital, provider, or healthcare system. Healthcare medical billing and reimbursement Remote in Washington State only Posted wage ranges represent the entire range from ...

EvergreenHealth

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... prior authorization in a hospital, provider, or healthcare system. Healthcare medical billing and reimbursement Remote in Washington State only Posted wage ranges represent the entire range from ...

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All JobsPrior Authorization Nurse JobsRemote Prior Authorization Nurse JobsRemote Prior Authorization Nurse Jobs in Renton, WA

Remote Prior Authorization Nurse information

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$19

$43

$73

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

As of Aug 14, 2026, the average hourly pay for remote prior authorization nurse in Renton, WA is $43.44, according to ZipRecruiter salary data. Most workers in this role earn between $33.27 and $48.65 per hour, depending on experience, location, and employer.

What is a remote prior authorization nurse?

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 as a remote prior authorization nurse?

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 remote prior authorization nurse do?

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 Renton, WA?

For Remote Prior Authorization Nurse jobs in Renton, WA, the most frequently searched job titles are:

What job categories do people searching Remote Prior Authorization Nurse jobs in Renton, WA look for?

The top searched job categories for Remote Prior Authorization Nurse jobs in Renton, WA are:

What cities near Renton, WA are hiring for Remote Prior Authorization Nurse jobs?

Cities near Renton, WA 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 Renton, WA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $90,347 per year, or $43.4 per hour.

Clinical Pharmacy Technician Sr - Medi-Cal Rx (Remote California)

Prime Therapeutics

Home, WA • Remote

$19.23 - $28.85/hr

Full-time

Posted 6 days ago

Prime Therapeutics rating

7.9

Company rating: 7.9 out of 10

Based on 48 frontline employees who took The Breakroom Quiz

17th of 112 rated pharmacies

Job description

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting TitleClinical Pharmacy Technician Sr - Medi-Cal Rx (Remote California)Job Description

The Senior Clinical Pharmacy Technician - Medi-Cal independently manages prior authorization requests, eligibility, pharmacy benefits, and claims using established clinical criteria. This role serves as a technical resource to team members, supports resolution of non-routine cases, and identifies opportunities to improve workflow efficiency.

Responsibilities

  • Independently review, research, and resolve prior authorization requests by applying clinical criteria, established guidelines, and professional judgment within defined protocols
  • Communicate coverage determinations, formulary alternatives, and prior authorization requirements to providers and internal stakeholders, ensuring clarity and accuracy in non-routine scenarios
  • Manage inbound and outbound inquiries related to eligibility, benefits, claims, and prior authorizations, resolving moderately complex issues and determining appropriate next steps
  • Escalate clinically complex or exception-based cases to a pharmacist, providing thorough documentation and relevant case context to support timely resolution
  • Educate providers and members on claims submission processes, appeals requirements, and reimbursement guidelines across multiple networks
  • Initiates, prioritize, and manage cases by accurately gathering and entering member and provider information
  • Identify trends, root causes, high-risk inquiries, and workflow gaps in daily operations and recommend process improvements to enhance efficiency, quality, and consistency
  • Serve as a resource to team members by providing guidance, answering process questions, and supporting onboarding activities
  • Other duties as assigned

Minimum Qualifications

  • High school diploma from an accredited school or equivalent GED
  • 2 years of work experience as a pharmacy technician
  • Licensed Pharmacy Technician in accordance with California state requirements

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

  • Strong knowledge of pharmacy workflows, terminology, and reimbursement processes
  • Ability to prioritize work and manage multiple assignments in a dynamic environment
  • Effective communication skills with the ability to guide and support team members
  • Proficiency in pharmacy systems and Microsoft Office applications

Preferred Qualifications

  • 1 year reimbursement experience
  • PBM or health care experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job

Potential pay for this position ranges from $19.23 - $28.85 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLCis proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

What Prime Therapeutics employees say

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About Prime Therapeutics

Sourced by ZipRecruiter

Prime Therapeutics, located in Eagan, MN, is a pharmacy benefits management company that has been serving the healthcare industry since its foundation. They are an integral participant in the medical sector, specifically in the realm of health insurance. They focus on providing innovative pharmacy benefits and services to more than 30 million members nationwide. Besides their main pharmacy benefit management, they offer mail service pharmacy, specialty pharmacy, benefits management, and consultative engagement services to ensure individuals have continuous access to affordable prescription drugs. Prime Therapeutics, founded around three decades ago, has grown to stand out as a leader in its industry, thanks to its commitment to improving the health of its clients.

Industry

Insurance services

Company size

1,001 - 5,000 Employees

Headquarters location

Eagan, MN, US

Year founded

1987

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