Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
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Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Quick apply
Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Position Summary The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their ...
Utilization review, prior authorization, or managed care experience preferred. * Active OH RN Licensure * Experienced with either Interqual or Milliman Licenses/Certifications: Current RN, required.
Utilization review, prior authorization, or managed care experience preferred. * Active OH RN Licensure * Experienced with either Interqual or Milliman Licenses/Certifications: Current RN, required.
Remote Prior Authorization Pharmacist
Columbus, OH · Remote
$56.25 - $67.50/hr
Collaborate with physicians, nurses, and medical directors on complex cases. * Document outcomes in ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Remote Prior Authorization Pharmacist
Columbus, OH · Remote
$56.25 - $67.50/hr
Collaborate with physicians, nurses, and medical directors on complex cases. * Document outcomes in ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Oncology Case Manager
Newark, OH · On-site
Prior authorization nurse is responsible for gathering and submitting the necessary paperwork and ... Requirements * Registered nurse with two years of experience in delivering nursing care
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Oncology Case Manager
Newark, OH · On-site
Prior authorization nurse is responsible for gathering and submitting the necessary paperwork and ... Requirements * Registered nurse with two years of experience in delivering nursing care
Oncology Case Manager
Newark, OH · On-site
Prior authorization nurse is responsible for gathering and submitting the necessary paperwork and ... Requirements * Registered nurse with two years of experience in delivering nursing care
Oncology Case Manager
Newark, OH · On-site
Prior authorization nurse is responsible for gathering and submitting the necessary paperwork and ... Requirements * Registered nurse with two years of experience in delivering nursing care
Oncology Case Manager
Newark, OH · On-site
Prior authorization nurse is responsible for gathering and submitting the necessary paperwork and ... Requirements * Registered nurse with two years of experience in delivering nursing care
Oncology Case Manager
Newark, OH · On-site
Prior authorization nurse is responsible for gathering and submitting the necessary paperwork and ... Requirements * Registered nurse with two years of experience in delivering nursing care
Conducts prior authorization reviews to determine financial responsibility Qualifications * 2 years Inpatient background with Hospital Nursing (Med-Surg, ER) * Well versed in Utilization Management ...
Conducts prior authorization reviews to determine financial responsibility Qualifications * 2 years Inpatient background with Hospital Nursing (Med-Surg, ER) * Well versed in Utilization Management ...
Clinical Financial Case Manager RN
Columbus, OH · On-site +1
Clinical Financial Case Manager RN Department: Health System Shared Services | Revenue Cycle ... prior authorization, precertification, care coordination, or related clinical revenue cycle ...
Clinical Financial Case Manager RN
Columbus, OH · On-site +1
Clinical Financial Case Manager RN Department: Health System Shared Services | Revenue Cycle ... prior authorization, precertification, care coordination, or related clinical revenue cycle ...
... and prior authorizations. Responsibilities also include reviewing patient histories for ... The RN delegates nursing tasks to licensed practical nurses (LPNs) and unlicensed assistive ...
... and prior authorizations. Responsibilities also include reviewing patient histories for ... The RN delegates nursing tasks to licensed practical nurses (LPNs) and unlicensed assistive ...
... and prior authorizations. Responsibilities also include reviewing patient histories for ... The RN delegates nursing tasks to licensed practical nurses (LPNs) and unlicensed assistive ...
... and prior authorizations. Responsibilities also include reviewing patient histories for ... The RN delegates nursing tasks to licensed practical nurses (LPNs) and unlicensed assistive ...
... prior authorizations or pre-certifications, etc.). * Respond to patient phone calls, as appropriate. * Maintain a clean and well-organized work area. Maintain patient confidentiality in alignment ...
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... prior authorizations or pre-certifications, etc.). * Respond to patient phone calls, as appropriate. * Maintain a clean and well-organized work area. Maintain patient confidentiality in alignment ...
... prior authorizations or pre-certifications, etc.). * Respond to patient phone calls, as appropriate. * Maintain a clean and well-organized work area. Maintain patient confidentiality in alignment ...
... prior authorizations or pre-certifications, etc.). * Respond to patient phone calls, as appropriate. * Maintain a clean and well-organized work area. Maintain patient confidentiality in alignment ...
... prior authorizations or pre-certifications, etc.). * Respond to patient phone calls, as appropriate. * Maintain a clean and well-organized work area. Maintain patient confidentiality in alignment ...
... prior authorizations or pre-certifications, etc.). * Respond to patient phone calls, as appropriate. * Maintain a clean and well-organized work area. Maintain patient confidentiality in alignment ...
Five years of clinical experience as a Registered Nurse, including two years in the following specialty area(s): Outpatient Surgical, Pain Management, Cosmetic Surgery, Prior Authorization, Medical ...
Five years of clinical experience as a Registered Nurse, including two years in the following specialty area(s): Outpatient Surgical, Pain Management, Cosmetic Surgery, Prior Authorization, Medical ...
Five years of clinical experience as a Registered Nurse, including two years in the following specialty area(s): Outpatient Surgical, Pain Management, Cosmetic Surgery, Prior Authorization, Medical ...
Five years of clinical experience as a Registered Nurse, including two years in the following specialty area(s): Outpatient Surgical, Pain Management, Cosmetic Surgery, Prior Authorization, Medical ...
Prior Authorization Rn information
See Columbus, OH salary details
$7.20 - $12.88
0% of jobs
$12.88 - $18.56
0% of jobs
$18.56 - $24.24
4% of jobs
$24.24 - $29.92
18% of jobs
$30.66 is the 25th percentile. Wages below this are outliers.
$29.92 - $35.59
20% of jobs
The median wage is $37.93 / hr.
$35.59 - $41.27
18% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$41.27 - $46.95
16% of jobs
$46.95 - $52.63
10% of jobs
$52.63 - $58.31
6% of jobs
$58.31 - $63.99
4% of jobs
$63.99 - $69.67
3% of jobs
$7
$40
$69
How much do prior authorization rn jobs pay per hour?
As of Jun 15, 2026, the average hourly pay for prior authorization rn in Columbus, OH is $40.81, according to ZipRecruiter salary data. Most workers in this role earn between $30.43 and $48.32 per hour, depending on experience, location, and employer.
How to make $300,000 a year as a nurse?
A Prior Authorization RN can earn $300,000 annually by gaining extensive experience, obtaining advanced certifications, and working in high-paying settings such as specialty clinics or insurance companies. Increasing workload, taking on leadership roles, or working overtime can also boost income, but reaching this level typically requires a combination of expertise, efficiency, and strategic employment choices.
How to make 150,000 as a nurse?
A Prior Authorization RN can earn $150,000 by gaining extensive experience, obtaining relevant certifications, and working in high-paying settings such as specialty clinics or insurance companies. Advancing to senior or managerial roles, working overtime, or taking on consulting opportunities can also increase earning potential.
What is the difference between Prior Authorization Rn vs Medical Coder?
| Aspect | Prior Authorization Rn | Medical Coder |
|---|---|---|
| Credentials | RN license, possibly certifications in case management or utilization review | Certification in coding (CPC, CCS), no RN license required |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Medical offices, hospitals, insurance companies |
| Primary Responsibilities | Reviewing and obtaining prior authorizations for treatments and procedures | Translating medical records into coded data for billing and documentation |
While both roles are integral to healthcare administration, the Prior Authorization RN focuses on obtaining approvals for patient care, requiring nursing credentials and clinical knowledge. In contrast, Medical Coders specialize in coding medical records for billing, emphasizing coding certifications. Understanding these differences helps healthcare professionals and job seekers identify the right career path or job opportunity.
What are the key skills and qualifications needed to thrive as a Prior Authorization RN, and why are they important?
To thrive as a Prior Authorization RN, you need a current RN license, strong clinical assessment skills, and a solid understanding of insurance guidelines and medical necessity criteria. Familiarity with utilization management software, electronic health records (EHRs), and payer-specific authorization systems is essential. Exceptional attention to detail, critical thinking, and effective communication help you advocate for patients and collaborate with healthcare providers and insurers. These skills ensure the efficient processing of authorizations, reduce delays in care, and support patients in receiving appropriate treatments.
What Does a Prior Authorization RN Do?
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.
What are some common challenges faced by Prior Authorization RNs, and how can they be addressed?
Prior Authorization RNs often navigate complex insurance guidelines and manage high volumes of requests, which can be challenging due to frequent policy updates and tight timelines. Staying organized, maintaining up-to-date knowledge of payer requirements, and leveraging electronic health record (EHR) systems can help streamline the process. Collaboration with providers and insurance representatives, as well as ongoing training, are essential for efficiently resolving issues and ensuring timely patient care.
Can nurses do prior authorizations?
Prior authorization nurses, often called utilization review nurses or case managers, are qualified to handle prior authorization requests. They review medical documentation, communicate with providers and insurance companies, and ensure compliance with payer requirements, often using electronic health record systems. Certification in case management or utilization review can enhance their ability to perform these tasks effectively.
How to make an extra 2000 a month as a nurse?
A Prior Authorization RN can increase income by taking on additional shifts, working overtime, or offering consulting services to healthcare providers. Developing specialized knowledge in insurance authorization processes and obtaining relevant certifications can also lead to higher-paying opportunities or freelance work outside regular hours.
What is a Prior Authorization RN?
A Prior Authorization RN is a registered nurse who specializes in reviewing and processing prior authorization requests for medical procedures, medications, or treatments. They evaluate clinical documentation to determine if requests meet insurance or regulatory criteria and often serve as a liaison between healthcare providers, patients, and insurance companies. Their role helps ensure that care is medically necessary and covered by the patient's health plan, streamlining access to important healthcare services while controlling costs.
More about Prior Authorization Rn jobs
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Full-time
Posted 12 days ago
Licking Memorial Hospital rating
6.9
Based on 38 frontline employees who took The Breakroom Quiz
529th of 999 rated hospitals
Job description
RN Case Manager Pain and Wound Clinics
Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately dedicated to improving the health and well-being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness.
When you join the LMHS team, you become a vital part of your local community Hospital. Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors. You will be providing care in a place in which you are personally connected, where the impact of your work extends beyond the Hospital doors and into the heart of our community. Our commitment to diversity, equity, and inclusion ensures that every member of our community is served with respect and compassion. Join us in our mission – dedicated to patient safety, utilizing state-of-the-art technology, and with a passionate team of highly trained and compassionate individuals who strive to improve the health of the community.
Position Summary
The case manager/prior authorization RN reviews upcoming medical treatments, services, or procedures for the pain and wound clinic's patient populations to determine whether their procedure or therapy qualifies for insurance coverage. The nurse assesses, evaluates, and provides recommendations to help ensure patients receive the services they need. Responsible for working denial queues to facilitate resolution for denied claims.
Responsibilities
- Accurate review of coverage benefits and payer policy limitations to determine the appropriateness of requested services.
- Works closely with pain, wound staff, and schedulers for upcoming patient procedures, rescheduled procedures, and denials.
- Follows up with patients as necessary.
- Performs timely prospective and retrospective reviews for services requiring prior authorization as well as timely concurrent review for continuation of care services.
- follows the authorization process using established criteria as set forth by the payer or clinical guidelines.
- Works with the pain and wound providers to facilitate/participate in peer-to-peer reviews.
- Manages electronic work queues and documents detail as applicable in the medical record.
- Works closely with clinical staff, clinic providers, compliance, billing, and coding to ensure cases are authorized appropriately.
- Facilitates the completion of medical leave and disability paperwork for patients as necessary.
- Completes Bureau of Workman’s Compensation (BWC) forms for patients as necessary.
- Assists patients with the appeal and denial process.
- Provides clinical information (utilization review) to external providers and managed care organizations.
- Participates in data collection for department dashboards.
- Coordinates insurance/patient’s condition changes with providers(s)/Physician’s Assistant as applicable.
Requirements
- Graduate from an accredited school of nursing and licensed in the state of Ohio.
- Previous case management, utilization review, or prior authorization experience preferred.
- Ability to carefully review medical records and ensure accuracy in data entry when providing information for prior authorization requests.
- Familiarity with electronic health records (EHR) and prior authorization platforms helpful.
- Excellent verbal and written communication skills
- Excellent computer skills.
Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations. Licking Memorial Health Systems does not discriminate against applicants because of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit-based factors protected by law.
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