Prior Authorization/Clinical Review Nurse (RN)

Elk Grove Village, IL

Full Time

Business Development

Experienced

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-being:

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

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