Prior Authorization/Clinical Review Nurse Hybrid

About Orsini Specialty Pharmacy 
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™.  
 
LIVE IT 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.  
 
Leading Quality, Integrity, Valued Partner, Empathy, Innovation, Team-First 

Position Summary
Salary Range: $70,000 - $80,000

The Prior Authorization 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. 

REQUIRED KNOWLEDGE, SKILLS & 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 systemsPreferred:
•    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

ESSENTIAL JOB 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

EMPLOYEE BENEFITS 

• BCBSL Medical
• Delta Dental
• EyeMed Vision
• 401k 
• Accident & Critical Illness
• Life Insurance
• PTO, Holiday Pay, and Floating Holidays
• Tuition Reimbursement