Prior Authorization/Clinical Review Nurse (RN)

Careers with real impact.

Every role at Orsini moves a patient closer to life-changing therapy. We partner with biopharma innovators, healthcare providers, and payers to make access simple, compassionate, and reliable - so no patient is left behind. Make your next role matter.

ABOUT ORSINI

Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™.

OUR MISSION

Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™.  

CORE VALUES

At the heart of our company culture, the Orsini LIVE IT Core Values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work.

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 

Disclaimer: The information written in this job description indicates the general nature and level of work to be performed. This job description is not designed to contain or be interpreted as totally comprehensive of every job duty, responsibility, or qualification required by an employee assigned to this job. While employed in this position, an employee may be required to perform other assignments not listed in this job description. 
 

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

​​​​​​​We offer a comprehensive benefits package designed to support your health, financial security, and overall well-b