Clinical Nurse Review Specialist

Jun 10, 2025

CarepathRx

Entry Level, Pharmacology, Prior Authorization, Registered Nurse | RN, Utilization Management | Utilization Review

Employment Type:

Regular | Perm Employee

Schedule:

Full-time

Remote Status:

Remote

License:

Any State | US, PA

CarepathRx

Entry Level, Pharmacology, Prior Authorization, Registered Nurse | RN, Utilization Management | Utilization Review

Employment Type:

Regular | Perm Employee

Schedule:

Full-time

Remote Status:

Remote

License:

Any State | US, PA

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

Qualify patients for home infusion therapy for admissions in accordance with company policies, CME Medicare guidelines, CMS HIT, ACHC standards and insurance requirements for authorizations. Support the intake and case management areas as appropriate.

Receptibilities

  • Assess patient’s appropriateness for admission in accordance with company policies and SOPs for admission criteria including Intravenous drug abuse and home safety.

  • Qualify patients for home infusion therapy bases on CMS Medicare guidelines, CMS HIT, insurance requirement for authorizations, compile all supporting documentation to be filed in the patients record and document accordingly.

  • Ongoing review of standards, CMS guidelines and insurance requirements to create and update processes to ensure compliance.

  • Review of policy and procedures, ensure they support standards, accreditation organization guidelines and state regulations. Assist with rollout as appropriate.

  • Participate in the creation, review and organization of educational documents including but not limited to teaching sheets, videos, and placemats.

  • Mentor new staff and support them through orientation.

  • Provide ongoing case management support to all patients, physicians and nurses including but not limited to troubleshooting pump problems, evaluating supply concerns and needs, transitioning patients to another agency or infusion company, and providing education as needed.

  • Provide support to the intake nurse for onboarding patients.

  • Carry out all job responsibilities according to the company’s core values and provide quality, comprehensive services to all customers through a team approach.

  • Performs other duties as assigned.

Skills & Abilities

  • Excellent written and verbal communication

  • Strong organizational and prioritization skills

  • Ability to assume a flexible work schedule

  • Home infusion/home health care experience, preferred

  • Strong critical thinking ability

  • Ability to analyze complex processes and scenarios

Requirements

  • Completion of accredited school of professional nursing is required

  • Bachelor of Science in Nursing (BSN) is preferred

  • Registered Nurse (RN) licensure is required

  • Proficiency in the Microsoft Suite

CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.