Prior Authorization Nurse

Infinity Care Solutions, a national mail order, compounding and specialty pharmacy, is seeking full-time Prior Authorization Nurses to join our team. In this role, you will serve as a critical link between healthcare providers, insurance companies, pharmacies, and internal teams by ensuring timely approval of prescribed medications. Your work will directly support continuity of care, reduce delays, resolve coverage issues, and maintain compliance with payer and regulatory requirements.

As a member of the Arcare Health Network, Infinity’s mission is to assist patients with their medication needs, in turn helping Arcare fulfill its mission as a not-for-profit Federally Qualified Health Center (FQHC).

We offer company paid medical, dental, vision, long term disability, and life insurance benefits, along with an excellent retirement plan. Starting pay will be determined by experience.

Responsibilities:

• Review and process prior authorization requests for medications.
• Review charts, office notes, labs, imaging, medication history, and supporting documentation.
• Submit and track requests and perform timely follow-up on pending cases.
• Communicate with insurers, provider offices, pharmacies, and internal teams regarding status and documentation needs.
• Assist with denials, appeals, reconsiderations, letters of medical necessity, and peer-to-peer coordination within nursing scope.
• Identify and escalate urgent, complex, or time-sensitive cases.
• Document approvals, denials, communications, and follow-up accurately in designated systems.
• Maintain knowledge of payer guidelines and Medicare, Medicaid, and commercial insurance requirements.
• Maintain HIPAA compliance and support department turnaround time, productivity, accuracy, and quality standards.
• Serve as a clinical resource to Prior Authorization Specialists and escalate matters outside nursing scope appropriately.

Required Qualifications:

• High School Diploma or GED.
• Current and unrestricted RN or LPN license.
• At least three years of nursing experience in one or more of the following areas: prior authorization, pharmacy, insurance, specialty medications, or related clinical operations.
• Must pass drug and background screening.

Preferred Skills & Experience:

• Strong verbal and written communication skills.
• Excellent organizational skills with the ability to manage multiple priorities simultaneously.
• Strong attention to detail and commitment to accuracy.
• Ability to work independently while collaborating effectively with cross-functional teams.
• Knowledge of HIPAA Privacy and Security Rules and experience handling protected health information (PHI).
• Knowledge of medical and pharmacy terminology, clinical documentation, and insurance processes.
• Experience working with community pharmacies, specialty pharmacies, Pharmacy Benefit Managers (PBMs), or manufacturer hub services.
• Knowledge of Medicare, Medicaid, and commercial insurance plans.
• Experience with EHR systems and CoverMyMeds or similar authorization platforms, pharmacy management systems, and Microsoft Office applications.
• Strong problem-solving, critical-thinking, and customer service skills.
• Ability to navigate changing priorities in a fast-paced healthcare environment.
• Demonstrated professionalism, integrity, and a patient-focused approach.

Job Type: Full-time

Pay: From $24.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Vision insurance

Shift availability:

• Day Shift (Preferred)

Ability to Commute:

• Bentonville, AR 72712 (Required)

Work Location: In person

Salary : $24