What Is a Prior Authorization Rn and How to Become One

By ZipRecruiter Marketplace Research Team

A prior authorization RN is a registered nurse who assesses applications for specific treatments, medical procedures, and medications. In this job, you review each request for medical coverage and determine the necessity or potential benefits of the treatment or medicine. You assess patient information and other factors to decide whether or not to authorize coverage. Your duties as a prior authorization RN also include reviewing denials of benefits and seeking additional information that could alter the initial decision. You document your findings for each case and present the evidence along with your decision. It is your job to review the case for each patient thoroughly while following all government regulations and healthcare provider policies.

The qualifications that you need to become a prior authorization RN include a nursing degree, a license, and the skills to analyze medical information. You can become an RN by earning a bachelor’s degree in nursing. You then take a licensing exam in your state and gain experience. Since your duties involve conducting a review of the coverage or benefits each patient is entitled to, some experience in medical coding or in a clerical position can increase your job opportunities. A prior authorization RN must follow all regulations regarding patient information, including HIPAA.