Clinical Nurse Navigator - Rheumatology

Overview

Employer Paid Medical, Dental, and Vision Benefits!

Min $39.36 Max $63.83

Mon-Fri

Days

40 hrs./week

Rheumatology Clinic

The Rheumatology RN Navigator provides comprehensive clinical and administrative support for patients with complex autoimmune and inflammatory diseases. This position serves as the primary clinical resource for patients throughout their treatment journey, coordinating care, providing disease‑specific education, managing medication therapies, and facilitating communication between patients, providers, pharmacies, infusion centers, insurance companies, and multidisciplinary care teams.

A primary responsibility of this role is managing specialty medication prior authorizations and appeals for biologic and targeted therapies, ensuring timely access to medically necessary treatment while minimizing delays in care. The RN Navigator collaborates closely with providers to obtain required clinical documentation, monitor treatment effectiveness, coordinate laboratory monitoring, and ensure compliance with payer requirements.

The Rheumatology RN Navigator works under the supervision of the Clinic Nursing Supervisor or Practice Manager while collaborating with physicians, infusion services, pharmacies, referral coordinators, and other healthcare professionals to provide high‑quality, patient‑centered care.

Essential Job Functions:

Medication & Prior Authorization Management

• Serve as the clinical lead for specialty medication prior authorizations, including biologics, biosimilars, JAK inhibitors, infusion therapies, and injectable medications.
• Complete comprehensive prior authorization requests utilizing evidence‑based clinical documentation and payer‑specific requirements.
• Prepare, submit, and monitor insurance appeals, peer‑to‑peer requests, and medical necessity documentation.
• Coordinate with specialty pharmacies, infusion centers, insurance companies, pharmaceutical manufacturers, and provider offices to ensure timely medication approval and initiation.
• Track authorization expirations and proactively initiate renewals to prevent interruptions in therapy.
• Monitor payer formulary changes and recommend appropriate alternatives when needed.
• Assist patients with enrollment in manufacturer copay assistance and patient assistance programs.
• Maintain current knowledge of Rheumatology treatment guidelines and specialty medications.

Patient Care Coordination

• Serve as the primary clinical contact for patients with chronic rheumatologic conditions.
• Coordinate laboratory monitoring required for disease‑modifying antirheumatic drugs (DMARDs), biologic therapies, and immunosuppressive medications.
• Monitor patients for medication effectiveness, adverse reactions, infections, and treatment compliance.
• Coordinate referrals between rheumatology and primary care, specialty providers, infusion centers, imaging departments, and laboratory services.
• Ensure continuity of care throughout diagnosis, treatment initiation, medication changes, and long‑term disease management.
• Coordinate infusion scheduling to align with medication approval and treatment timelines.

Patient Education

• Educate patients regarding autoimmune diseases, medication administration, side effects, infection prevention, immunizations, and lifestyle modifications.
• Provide injection teaching for self‑administered biologic medications.
• Educate patients regarding laboratory monitoring schedules and medication safety.
• Reinforce provider treatment plans and ensure patient understanding of disease management.

Epic & Clinical Communication

• Manage Epic InBasket messages, patient portal communications, prescription refill requests, and provider messaging.
• Perform telephone triage utilizing nursing judgment for symptom management and medication‑related concerns.
• Document all clinical interventions accurately and timely within the electronic medical record.
• Coordinate prescription refills, specialty pharmacy communications, and medication monitoring.

Quality & Program Development

• Monitor prior authorization turnaround times, denial rates, medication access delays, and quality metrics.
• Develop standardized workflows to improve efficiency of…