Hybrid RN: Clinical Authorization & Appeals Specialist

PANTHERx Rare Pharmacy; Pittsburgh (Allegheny County); Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Hybrid/remote work

401K with employer matching

Life insurance

Short/long term disability

Employee Assistance Program

Paid time off

Paid holidays

Job summary

PANTHERx Rare Pharmacy is seeking a Clinical Authorization and Appeals Specialist in Pittsburgh, PA. This role supports health care providers with prior authorizations and appeals, coordinating documentation and program initiatives to improve patient care.

The position requires an RN with 1–3 years of direct patient care, strong writing skills, and solid MS Office proficiency. Hybrid/remote options are available, with a focus on collaborative, cross-functional teamwork.

Qualifications

• RN with 1–3 years direct patient care experience.
• Strong writing and grammar skills.
• Strong organizational skills; proficient with MS Office and Windows.

Responsibilities

• Educates health care providers regarding prior authorization and appeals criteria for prescribed therapies.
• Assesses clinical documentation provided and aligns with specific plan criteria.
• Creates initiatives to increase patient adherence and optimize patient care.
• Possesses a broad and deep understanding of assigned disease states, products, and clinical programs.
• Closes collaboration with program team members and external stakeholders.
• Documents cases accurately using call management software.
• Demonstrates sound judgement to make independent clinical decisions.
• Fosters teamwork and supports collaboration at all levels of the organization.

Skills

RN

Medical writing

Communication

Organization

Education

RN degree (Associate or Bachelor's)

Tools

Microsoft Office

Windows

Job description

PANTHERx Rare Pharmacy is seeking a Clinical Authorization and Appeals Specialist in Pittsburgh, PA. This role supports health care providers with prior authorizations and appeals, coordinating documentation and program initiatives to improve patient care.

The position requires an RN with 1–3 years of direct patient care, strong writing skills, and solid MS Office proficiency. Hybrid/remote options are available, with a focus on collaborative, cross-functional teamwork.