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Remote Prior Authorization Nurse Jobs (NOW HIRING)

PainPoint

Prior Authorization Team Lead

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Thrive in a collaborative remote environment. Qualifications * High School Diploma or GED required. * At least one (1) year of prior authorization experience in a clinical setting required.

WELLDYNE

Prior Authorization Technician II

$28K - $40K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Prior Authorization Technician II This position is fully remote. The required working schedule is 8:00 AM - 5:00 PM Mountain Time (MST) or 10:00 AM - 7:00 PM Eastern Time (EST) , depending on ...

University of Utah

Prior Authorization Representative I

$17.50 - $22.25/hr

Overview This position is primarily remote work, but candidate must reside within the state of Utah ... This position works with physicians, nurses, clinic managers, and financial advocates to resolve ...

New

WellDyne

Prior Authorization Technician II

$18 - $21.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Prior Authorization Technician II This position is fully remote. The required working schedule is 8:00 AM - 5:00 PM Mountain Time (MST) or 10:00 AM - 7:00 PM Eastern Time (EST) , depending on ...

PainPoint Health

Prior Authorization Team Lead

Atlanta, GA · Remote

$23/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Prior Authorization Team Lead Full-Time | Remote | $23/hr Schedule: Monday-Friday 8:00 AM-4:30 PM About DxTx DxTx Pain & Spine is a physician-aligned partner organization dedicated to supporting ...

Onco360

Pharmacy Prior Authorization Specialist

Buffalo, NY · On-site +1

$19.75 - $25.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Pharmacy Prior Authorization Specialist - Onco360 Pharmacy Buffalo, NY | Full-Time | Starting at ... Remote work possible after initial on-site training. Company Benefits * Medical; Dental; Vision ...

Onco360

Pharmacy Prior Authorization Specialist

Louisville, KY · On-site +1

$18.75 - $24.25/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Remote work possible after initial on-site training. Why Join Us? * A career with purpose: Help ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

Availity

Senior Product Director, Prior Authorization (Remote)

$238K - $249K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Bachelor's degreerequired; advanced degree (MBA, MHA, MPH, RN, MD) strongly preferred. * Direct ... Deepexpertisein prior authorization,utilizationreview, and medical cost containment strategies.

Onco360

Pharmacy Prior Authorization Specialist

Waltham, MA · On-site +1

$22.25 - $29/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Remote work possible after initial on-site training. Why Join Us? * A career with purpose: Help ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

Onco360

Pharmacy Prior Authorization Specialist

Scottsdale, AZ · On-site +1

$20.75 - $26.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Remote work possible after initial on-site training. Why Join Us? * A career with purpose: Help ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

US Tech Solutions

Pharmacist - Prior Authorization #

$59.50 - $71.75/hr

Remote Duration: 12+ Months As a Clinical Pharmacist Advisor Medicare, you will be directly ... Prior Authorization Pharmacy Benefit Management Medicare Part D Education: Bachelor's degree in ...

Onco360

Pharmacy Prior Authorization Specialist

Albuquerque, NM · Remote

$19.75 - $25.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Remote work if licensed in State of New Mexico. Why Join Us? * A career with purpose: Help patients ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

Onco360

Pharmacy Prior Authorization Specialist

Houston, TX · On-site +1

$19.50 - $25.25/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Remote work possible after initial on-site training. Why Join Us? * A career with purpose: Help ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

Onco360

Pharmacy Prior Authorization Specialist

Woodridge, IL · On-site +1

$20.25 - $26.25/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Remote work possible after initial on-site training. Why Join Us? * A career with purpose: Help ... Manage prior authorization requests and appeals with insurance carriers. * Collaborate with ...

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

As of Aug 17, 2026, the average hourly pay for remote prior authorization 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 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.

More about Remote Prior Authorization Nurse jobs

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Cities with the most Remote Prior Authorization Nurse job openings:

What are the most commonly searched types of Prior Authorization Nurse jobs?

The most popular types of Prior Authorization Nurse jobs are:

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Remote Prior Authorization Nurse jobs near you
Infographic showing various Remote Prior Authorization Nurse job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Clinical Review Nurse - Prior Authorization

Centene Corporation

Remote

$27.02 - $48.55/hr

Other

Medical, Retirement, PTO

Posted 4 days ago

Centene rating

8.4

Company rating: 8.4 out of 10

Based on 404 frontline employees who took The Breakroom Quiz

14th of 887 rated healthcare providers

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Work Location
This is a fully remote role. Candidates must hold active New York State Registered Nurse (RN) licensure and be willing to work Eastern Time (ET/EST) hours.
Licensure Requirement
Active and unrestricted New York State Registered Nurse (RN) licensure is required for consideration.
Schedule
This position follows a Monday-Friday schedule from 8:30 AM to 5:00 PM Eastern Time (ET/EST), with a one-hour assigned lunch break. Candidates must be able to work during these hours.
Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.

  • Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
  • Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
  • Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member
  • Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care
  • Assists with service authorization requests for a member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities
  • Collects, documents, and maintains all member's clinical information in health management systems to ensure compliance with regulatory guidelines
  • Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members
  • Provides feedback on opportunities to improve the authorization review process for members
  • Performs other duties as assigned
  • Complies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience.
  • Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
  • Knowledge of Medicare and Medicaid regulations preferred.
  • Knowledge of utilization management processes preferred.
License/Certification:
  • For Fidelis Plan Only: A clinical degree as a healthcare professional is required along with the appropriate license. Examples include Nursing, PT and OT.

Pay Range: $27.02 - $48.55 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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