Position Overview
We are seeking a detail-oriented and compassionate Registered Nurse (RN) to join our team in a vital role that blends clinical expertise with patient advocacy. This position focuses on prior authorization for prescription medications and specialty medical utilization management, particularly for patients with rare disorders. The RN will work closely with prescribers, patients, and families to support medically necessary treatments while staying informed about evolving clinical guidelines and therapeutic advancements.
Key Responsibilities
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Communicate with third-party payers and providers regarding clinical reviews for initial and continued care.
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Support the appeals process to address insurance denials or benefit exclusions.
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Accurately enter prior authorizations into internal systems to ensure seamless claims processing.
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Collaborate with prescribers to obtain essential clinical information related to prescription orders.
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Develop individualized care plans for patients and conduct follow-up assessments.
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Handle both inbound and outbound calls involving patients, providers, and office staff.
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Provide clinical guidance related to medication use and treatment protocols.
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Contribute to the creation and refinement of internal clinical standards and workflows.
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Coordinate closely with pharmacists to ensure comprehensive patient care.
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Uphold a professional demeanor and represent the organization positively at all times.
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Adhere to company policies and procedures as outlined in the employee handbook and leadership directives.
Required Qualifications
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Registered Nurse licensure from a program accredited by the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC).
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Valid nursing license in the pharmacy’s home state and in the employee’s state of residence (if remote).
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Proven experience working as a nurse in a clinical healthcare setting.
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Solid understanding of medications, dosages, and medical terminology.
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Strong communication and customer service skills.
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Exceptional organizational skills and attention to detail.
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Dependable, with a proactive and quality-driven approach to patient care.
Preferred Qualifications
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Associate or Bachelor’s Degree in Nursing from an accredited program (CCNE or NLNAC).
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2–3 years of hands-on nursing experience, ideally in a prior authorization, pharmacy, or clinical support role.
Key Competencies
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Strong verbal and written communication
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High standards for quality and compliance
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Accountability and attention to detail
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Productivity and organizational focus
Work Environment
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Combination of on-site pharmacy setting and remote work.
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Regular use of standard office equipment, including computers, telephones, printers, and fax machines.
Physical Requirements
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Must be able to talk and listen regularly while performing job duties.
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Frequently required to stand, walk, use hands, and reach with arms.
Benefits
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401(k) retirement plan with employer matching
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Comprehensive health, dental, and vision insurance
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Life and disability insurance
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Health Savings Account (HSA) and Flexible Spending Account (FSA)
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Paid time off (PTO)
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Employee Assistance Program (EAP)