Hybrid/Remote Clinical Authorization & Appeals Specialist

PANTHERx Rare, LLC.; Pittsburgh (Allegheny County); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Hybrid/Remote work

Healthcare benefits

401K with employer matching

Paid time off

Life insurance & disability

Job summary

PANTHERx Rare Pharmacy in Pittsburgh, PA is seeking a Clinical Authorization and Appeals Specialist to support providers with prior authorizations and appeals, ensuring alignment with plan criteria and timely submissions. The role requires an RN with 1–3 years in community health, strong writing and organizational skills, and the ability to work independently in a hybrid work environment.

You will collaborate with internal teams and external stakeholders, educate providers, document cases, and

Qualifications

• Associate or bachelor's degree from an accredited nursing school as an RN.
• 1-3 years of direct patient care in community health or similar setting.
• Strong writing and grammar skills.
• Proficient in Microsoft Office and Windows.
• Ability to work independently and meet goals.

Responsibilities

• Educates health care providers on prior authorization criteria.
• Assesses clinical documentation and aligns with plan criteria.
• Creates initiatives to increase patient adherence and optimize care.
• Possesses broad understanding of disease states, products, and programs.
• Collaborates with program team and external stakeholders.
• Documents cases using call management software.
• Demonstrates judgment to make independent clinical decisions.
• Fosters teamwork and supports collaboration at all levels.

Skills

RN

Community health experience

Strong writing

Organizational skills

Microsoft Office

Independent work

Education

Associate or Bachelor's degree in nursing (RN)

Tools

Microsoft Office

Windows

Job description

PANTHERx Rare Pharmacy in Pittsburgh, PA is seeking a Clinical Authorization and Appeals Specialist to support providers with prior authorizations and appeals, ensuring alignment with plan criteria and timely submissions. The role requires an RN with 1–3 years in community health, strong writing and organizational skills, and the ability to work independently in a hybrid work environment.

You will collaborate with internal teams and external stakeholders, educate providers, document cases, and