Prior Authorization/Clinical Review Nurse (RN)

Orsini - Rare Disease Pharmacy Solutions; Elk Grove Village (IL); On-site; USD 68,000 - 92,000; Full time

Benefits offered by this job

Medical Coverage

Dental Coverage

Vision Coverage

401(k) with employer match

Accident and Critical Illness coverage

PTO and holidays

Life insurance

Tuition reimbursement

Job summary

Orsini Rare Disease Pharmacy Solutions seeks a Prior Authorization/Clinical Review Nurse (RN) to review clinical documentation, evaluate medical necessity, and obtain prior authorizations for prescribed medications, infusions, and related therapies. You will collaborate with prescribers, payers, patients, and internal teams to navigate complex requirements and ensure timely access to care.

Based in Elk Grove Village, IL, this role requires an Illinois RN license, an associate degree, and 2+

Qualifications

• Active, unencumbered Illinois RN license
• Associate degree in nursing or higher
• 2+ years of clinical nursing experience
• 1+ year of prior authorization/utilization review experience
• Strong knowledge of insurance payer requirements and medical necessity

Responsibilities

• Review clinical documentation to verify medical necessity for prior authorization requests
• Prepare and submit prior authorization requests for specialty meds and related therapies
• Communicate with insurers, physicians, and internal teams to resolve authorization issues
• Provide timely updates to patients and care teams about authorization status
• Document interactions and actions in the patient record and EHR systems
• Stay updated on payer requirements, formulary changes, and regulatory guidelines
• Monitor pending authorizations to prevent treatment delays
• Maintain patient confidentiality in line with HIPAA
• Contribute to quality improvement initiatives in authorization workflows

Skills

Clinical nursing experience

Prior authorization knowledge

Communication

EMR/EHR proficiency

Critical thinking

Education

Associate degree

Tools

CoverMyMeds

Job description

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™.

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.

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™.

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
• Stay current on payer requirements, formulary changes, and industry regulations affecting prior authorization processes
• Monitor and follow up on pending authorizations to prevent treatment delays
• Maintain patient confidentiality and comply with HIPAA regulations
• Participate in quality improvement initiatives related to the authorization workflow

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
• Proficiency in EMR/EHR and pharmacy benefit management systems
• Excellent communication and critical thinking skills

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-being:

• Medical Coverage, Dental, and Vision Coverage
• 401(k) with employer match
• Accident and Critical Illness coverage
• Generous PTO, paid holidays, and floating holidays
• Company-paid life insurance options
• 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):

https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf

Right to Work Poster (English & Spanish):

https://www.e-verify.gov/sites/default/files/everify/posters/IER_RightToWorkPoster.pdf