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Vice President Prior Authorization Rn Jobs (NOW HIRING)

ASPIRUS HEALTH

VP- SYSTEM NURSING OPERATIONS

Wausau, WI · On-site

The VP, System Nursing Operations is considered the primary executive nursing backup to the Aspirus ... Unencumbered Registered Nurse license in the state of Wisconsin, Michigan, or Minnesota required.

InnovAge

VP, Nursing Operations

Denver, CO · On-site +1

$165K - $200K/yr

In addition, the Vice President is the strategic lead for the Hot Spot Team, deployed to centers as ... Current Registered Nurse License required in all states where InnovAge operates. Must hold a ...

InnovAge

VP, Nursing Operations

Denver, CO

$200K - $340K/yr

... Vice President of Nursing Operations leads and manages a national team of ... RN Case Managers. The primary responsibility of this role is to ensure the provision of ...

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Vice President Prior Authorization Rn information

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$43.5K

$157.5K

$277.5K

How much do vice president prior authorization rn jobs pay per year?

As of Jun 23, 2026, the average yearly pay for vice president prior authorization rn in the United States is $157,532.00, according to ZipRecruiter salary data. Most workers in this role earn between $115,000.00 and $190,000.00 per year, depending on experience, location, and employer.

Do nurses handle prior authorization?

Nurses, including those in roles like Vice President Prior Authorization RN, often assist with prior authorization processes by reviewing medical documentation and supporting the approval process. However, the primary responsibility for obtaining prior authorization typically falls to specialized staff or healthcare providers, with nurses providing support and ensuring compliance. Knowledge of insurance policies and documentation requirements is essential in these roles.

What are prior authorization jobs?

Prior authorization jobs, such as those for a Vice President Prior Authorization RN, involve reviewing and approving medical procedures, treatments, or medications before they are provided to ensure they meet insurance or healthcare guidelines. These roles require knowledge of healthcare policies, strong communication skills, and often involve working with electronic health records and insurance companies to facilitate timely approvals.

What is the difference between Vice President Prior Authorization Rn vs Prior Authorization Nurse Manager?

AspectVice President Prior Authorization RnPrior Authorization Nurse Manager
CredentialsRN license, leadership experience, possibly advanced degreesRN license, management experience
Work EnvironmentExecutive leadership, strategic planning, policy developmentOperational management, team oversight, process improvement
Employer & IndustryHealth insurance companies, healthcare organizationsHospitals, healthcare facilities, insurance providers
Search & Comparison IntentHigh-level strategic roles, executive responsibilitiesOperational, team management roles

The Vice President Prior Authorization Rn focuses on strategic leadership and policy development at an executive level, while the Prior Authorization Nurse Manager handles day-to-day team management and operational tasks. Both roles require RN licensure, but differ significantly in scope and responsibilities.

What jobs can I do if I don't want to be a nurse anymore?

A Vice President of Prior Authorization Rn typically has healthcare management skills, which can be transferred to roles such as healthcare administrator, medical director, or healthcare consultant. These positions often require leadership, knowledge of medical policies, and experience with healthcare regulations, and they may involve overseeing clinical operations or compliance efforts.

How to make 150,000 as a nurse?

A Vice President of Prior Authorization Nursing can earn $150,000 or more by gaining extensive experience in healthcare administration, obtaining relevant certifications, and working in organizations that value leadership in clinical review processes. Advanced degrees such as a master's in nursing or healthcare administration can also enhance earning potential, especially in senior or executive roles overseeing prior authorization teams.
What cities are hiring for Vice President Prior Authorization Rn jobs? Cities with the most Vice President Prior Authorization Rn job openings:
What are the most commonly searched types of Prior Authorization Rn jobs? The most popular types of Prior Authorization Rn jobs are:
What job categories do people searching Vice President Prior Authorization Rn jobs look for? The top searched job categories for Vice President Prior Authorization Rn jobs are:
Vice President Prior Authorization Rn jobs near you
Infographic showing various Vice President Prior Authorization Rn job openings in the United States as of June 2026, with employment types broken down into 52% Full Time, 15% Part Time, 1% Temporary, and 32% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $157,532 per year, or $75.7 per hour.

VP of Utilization Review

ODYSSEY BEHAVIORAL GROUP

Franklin, TN • On-site, Remote

Full-time

Posted 24 days ago

Job description

Position Summary
The Vice President of Utilization Review (VP of UR) provides strategic and operational leadership for the enterprise-wide Utilization Review function across all behavioral health service lines and levels of care. This executive leader is responsible for developing, standardizing, optimizing, and overseeing utilization management practices that support quality care, appropriate reimbursement, regulatory compliance, payer relationships, and organizational financial performance.
The VP of UR partners closely with Executive Leadership, Clinical Operations, Revenue Cycle, Admissions, Nursing, Compliance, Business Development, and Finance to ensure utilization management processes align with organizational goals, evidence-based practices, and payer requirements. This role is responsible for driving performance improvement initiatives related to authorizations, denials management, length of stay optimization, appeals, documentation integrity, and payer strategy.
The VP of UR serves as the enterprise subject matter expert for utilization management and develops scalable systems, reporting structures, KPIs, and accountability processes to support continued organizational growth and operational excellence.
Relationships and Contacts
Within the organization: Maintains frequent and collaborative working relationships with the Chief Clinical Officer, Executive Leadership, Divisional CEOs, Chief Financial Officer, Revenue Cycle leadership, Business Development, Admissions, Nursing leadership, Medical leadership, Compliance, Risk Management, Operations leadership, and all clinical team members across the organization.
Outside the organization: Develops and maintains strategic relationships with insurance organizations, managed care companies, external review organizations, payer representatives, referral partners, vendors, and consultants, as appropriate.
Position Responsibilities
Essential Responsibilities
  1. Provides executive oversight and strategic direction for all enterprise Utilization Review operations across multiple facilities, service lines, and states.
  2. Develops and implements standardized enterprise-wide UR processes, workflows, policies, and documentation standards to improve operational consistency and payer outcomes.
  3. Oversees authorization management, concurrent review processes, denial prevention strategies, appeals management, retrospective reviews, and payer escalation processes.
  4. Partners with Clinical, Nursing, Admissions, and Revenue Cycle teams to ensure documentation supports medical necessity, level of care determinations, and reimbursement optimization.
  5. Develops enterprise KPI dashboards and reporting structures related to denials, overturn rates, authorization timeliness, payer trends, reimbursement performance, length of stay management, and utilization efficiency.
  6. Identifies trends, gaps, and opportunities within utilization management processes and leads performance improvement initiatives to enhance operational and financial outcomes.
  7. Collaborates with executive leadership regarding payer contracting strategy, authorization challenges, network access issues, and value-based care initiatives.
  8. Serves as an organizational expert regarding payer requirements, medical necessity criteria, utilization management regulations, and behavioral health reimbursement practices.
  9. Oversees recruitment, onboarding, training, mentorship, performance management, and leadership development for enterprise UR leadership and staff.
  10. Conducts regular audits and quality reviews to ensure compliance with regulatory requirements, payer expectations, and organizational standards.
  11. Develops escalation pathways and support structures for complex cases, difficult payer interactions, and high-risk authorization issues.
  12. Leads enterprise education initiatives related to documentation integrity, medical necessity standards, payer trends, and authorization best practices.
  13. Collaborates with Information Technology and EHR leadership to optimize utilization review workflows, reporting capabilities, automation opportunities, and data integrity.
  14. Supports organizational growth initiatives, acquisitions, new program development, and expansion strategies through scalable utilization management processes.
  15. Participates in executive meetings, operational reviews, and strategic planning initiatives as a key organizational leader.
  16. Maintains strict confidentiality of all company, departmental, patient, payer, and healthcare provider information.
  17. Reports enterprise risks, payer concerns, and operational barriers to executive leadership with recommendations for resolution and mitigation.

Education and Experience
Bachelor's degree required, master's degree in nursing, Healthcare Administration, Business Administration, or related healthcare field preferred. Clinical licensure preferred (RN, LCSW, LPC, LMFT, or comparable behavioral health licensure). Requires a minimum of seven (7) years of progressive Utilization Review leadership experience within behavioral health, including large multi-site or enterprise oversight responsibilities. Previous experience developing KPIs, reporting analytics, dashboards, and executive-level operational presentations is required.
Physical Requirements
  • While performing the duties of this job, the employee must communicate with internal and external stakeholders and vendors.
  • Tolerant to various noise levels: noise level in the work environment varies - may be quiet to moderate noise levels.
  • Job performance will require the ability to move throughout the building as well as sit or remain stationary for extended periods of time.
  • While performing the duties of this job, the employee may be required to talk or hear, sit, stand, walk, and reach.
  • Ability to travel by various forms of transportation, including automobiles and airplane.

Additional Requirements
  • Position requires incumbent to have a valid driver's license and acceptable driving record.
  • Clearance of TB test, and any other mandatory state/federal requirements.

Skill Competencies
  • Demonstrates executive leadership and strategic planning capabilities.
  • Demonstrates the ability to lead enterprise-wide operational change and process improvement initiatives.
  • Demonstrates extensive knowledge of behavioral health levels of care, medical necessity criteria, payer operations, reimbursement methodologies, and regulatory requirements.
  • Demonstrates experience leading large-scale operational improvement initiatives and enterprise standardization efforts.
  • Demonstrates a strong understanding of managed care contracting, denial management, appeals processes, and payer negotiation strategies.
  • Demonstrates strong financial acumen with understanding of reimbursement, payer strategy, and revenue optimization.
  • Demonstrates ability to successfully function under pressure in critical and rapidly changing situations.
  • Demonstrates ability to effectively manage conflict, escalation, and crisis situations.
  • Demonstrates strong analytical, problem-solving, and decision-making skills.
  • Demonstrates exceptional organizational and project management skills.
  • Demonstrates excellent interpersonal, relationship-building, and executive communication skills.
  • Demonstrates the ability to influence cross-functional teams and build organizational alignment.
  • Demonstrates a prominent level of discretion, professionalism, and accountability.
  • Demonstrates strong diligence and follow-through.
  • Demonstrates proficiency with Microsoft Office programs, reporting systems, EHR platforms, and data analytics tools.
  • Consistently demonstrates and models alignment with company mission, values, and leadership expectations.

Odyssey Behavioral Healthcare, LLC provides equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. Equal employment opportunities apply to all terms and conditions of employment. Odyssey reserves the right to modify, interpret, or apply this job description in any way the organization desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. Reasonable accommodations may be made to reasonably accommodate qualified individuals with disabilities. This job description is not an employment contract, implied or otherwise. The employment relationship remains "At-Will."

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