Prior Authorization Nurse (RN or LPN)

York-General-1; York (NE); On-site; USD 52,000 - 74,000; Full time

Job summary

York General invites applications for a Family Medicine Prior Authorization Nurse (LPN or RN) on a full-time basis. You will coordinate insurance prior authorizations for medications, procedures, diagnostics, and equipment to ensure timely patient access, collaborating with providers, pharmacies, insurers, and patients.

The role requires an accredited nursing degree, at least one year of nursing experience, and solid skills in organization, communication, and EMR use.

Qualifications

• Graduate of an accredited nursing program.
• Minimum of one year of nursing experience.
• Ability to interpret clinical documentation and payer requirements.
• Proficiency with EMR and healthcare technology systems.

Responsibilities

• Review provider orders, treatment plans, and documentation to determine authorization requirements.
• Submit and manage prior authorization requests for medications, procedures, testing, and other services.
• Communicate with insurance companies regarding coverage determinations, denials, appeals, and requirements.
• Coordinate with providers, clinic staff, pharmacies, and patients to support access to care.
• Manage denial appeals, reconsiderations, and peer-to-peer review processes.
• Maintain accurate documentation within the EMR.
• Stay current on payer requirements and best practices; monitor outcomes.

Skills

Organizational skills

Self-motivated

Detail-oriented

Communication

Critical thinking

Time management

Education

Nursing degree/diploma

Tools

Electronic Medical Records (EMR)

Job description

Position Title: Family Medicine Prior Authorization Nurse (LPN or RN) - Full Time (FT)

Department: Family Medicine

Reports to: Director of Nursing, Family Medicine

York General is seeking a detail-oriented and collaborative Prior Authorization Nurse (RN or LPN) to support our Family Medicine team. In this role, you will coordinate insurance prior authorizations for medications, procedures, diagnostic testing, durable medical equipment, and other healthcare services, helping patients receive timely access to the care they need. You will work closely with providers, clinical staff, pharmacies, insurance companies, and patients to navigate authorization requirements and resolve coverage issues.

What You'll Do:

• Review provider orders, treatment plans, and clinical documentation to determine authorization requirements.
• Submit and manage prior authorization requests for medications, procedures, testing, and other services.
• Communicate with insurance companies regarding coverage determinations, denials, appeals, and authorization requirements.
• Coordinate with providers, clinic staff, pharmacies, and patients to support treatment access and care continuity.
• Manage denial appeals, reconsiderations, and peer-to-peer review processes.
• Maintain accurate documentation within the electronic medical record (EMR).
• Stay current on payer requirements, regulatory standards, and authorization best practices.
• Monitor authorization outcomes and identify opportunities to improve workflows and patient access.

What You'll Bring:

• Graduate of an accredited nursing program.
• Minimum of one year of nursing experience.
• Strong organizational, communication, critical thinking, and time management skills.
• Ability to interpret clinical documentation and payer requirements.
• Proficiency with electronic medical records and healthcare technology systems.

Skills

Organizational skills

Novice

Self-motivated

Novice

Detail-oriented

Novice

Experience

1 year: Nursing experience

Licenses & Certifications

Registered Nurse

Licensed Practical Nurse

Equal Opportunity Employer
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