Prior Authorization/Clinical Review RN (Specialty Pharmacy)

About the role

The Prior Authorization/Clinical Review Nurse (RN) ensures patients receive timely access to specialty and rare disease therapies by reviewing clinical documentation, confirming medical necessity, and securing prior authorizations. Working closely with prescribers, payers, patients, and internal pharmacy teams, the RN navigates complex authorization processes to prevent treatment delays.

Key responsibilities

• Review patient clinical records and verify medical necessity according to payer policies and clinical guidelines.
• Prepare, submit, and track prior authorization requests for specialty medications, infusions, and related therapies.
• Communicate with insurance companies, physician offices, and internal departments to resolve authorization issues.
• Provide clear updates to patients and care teams on authorization status.
• Document all interactions, decisions, and follow‑up actions in electronic patient records.
• Monitor pending authorizations and proactively address potential delays.
• Stay current on payer requirements, formulary changes, and regulatory updates.

Required profile

• Active Registered Nurse (RN) license.
• Experience in specialty pharmacy, rare/orphan disease therapies, or prior authorization processes.
• Strong understanding of medical necessity criteria and payer guidelines.
• Excellent communication and collaboration skills.

Required skills

• Clinical documentation review.
• Prior authorization submission and tracking.
• Knowledge of specialty pharmacy workflows.

What we offer

• Competitive salary of $80,000 per year.
• Opportunity to work within a mission‑driven company focused on rare disease therapies.
• Collaborative environment with biopharma, providers, and payers.