Prior Authorization/Clinical Review Nurse (RN)

Compensation & Location The salary for this role is $80,000. This position is based out of our Elk Gove Village location. Position Summary The Prior Authorization/Clinical Review Nurse (RN) is responsible for reviewing clinical documentation, evaluating medical necessity, and obtaining prior authorizations for prescribed medications, treatments, and procedures. This role ensures timely, accurate processing of authorization requests to support patient access to care, with a focus on specialty pharmacy and rare/orphan disease therapies. The RN collaborates with prescribers, payers, patients, and internal pharmacy teams to navigate complex authorization requirements and ensure compliance with all regulatory and payer guidelines. Essential Duties Review patient clinical documentation and verify medical necessity for prior authorization requests in alignment with payer policies and clinical guidelines Prepare and submit prior authorization requests for specialty medications, infusions, and related therapies Communicate with insurance companies, physician offices, and internal departments to resolve authorization issues and obtain approvals Provide clear updates to patients and care teams on the status of prior authorizations Document all interactions, decisions, and follow-up actions in the patient record and electronic systems Monitor and follow up on pending authorizations to prevent treatment delays Stay current on payer requirements, formulary changes, and industry regulations affecting prior authorization processes Participate in quality improvement initiatives related to the authorization workflow Maintain patient confidentiality and comply with HIPAA regulations Knowledge, Skills, And Training Required: Active, unencumbered Registered Nurse (RN) license in Illinois Associate degree 2+ years of clinical nursing experience 1+ year of experience in prior authorization, utilization review, case management, or a related role Strong knowledge of insurance plans, payer authorization requirements, and medical necessity criteria Excellent communication and critical thinking skills Proficiency in EMR/EHR and pharmacy benefit management systems Preferred: Experience in specialty pharmacy, infusion services, or rare disease care coordination Prior work in a managed care or payer environment Prior experience with CoverMyMeds for clinical question submissions Employee Benefits Medical Coverage, Dental, and Vision Coverage 401(k) with employer match Accident and Critical Illness coverage Company-paid life insurance options Generous PTO, paid holidays, and floating holidays Tuition reimbursement program Equal Employment Opportunity Orsini Rare Disease Pharmacy Solutions is committed to the principle of Equal Employment Opportunity for all employees and applicants. It is our policy to ensure that both current and prospective employees are afforded equal employment opportunity without consideration of race, religious creed, color, national origin, nationality, ancestry, age, sex, marital status, sexual orientation, or present or past disability (unless the nature and extent of the disability precludes performance of the essential functions of the job with or without a reasonable accommodation) in accordance with local, state and federal laws. Americans With Disabilities Act Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law. E-Verify Participation Notice We participate in the federal E-Verify program to confirm the identity and employment eligibility of all newly hired employees. All offers of employment are contingent upon the successful completion of Form I-9 and verification through the E-Verify system. For more information about E-Verify, please review the official notices below: E-Verify Participation Poster (English & Spanish): Right to Work Poster (English & Spanish): #J-18808-Ljbffr