Infusion Clinical Review Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Perform prior authorization reviews utilizing clinical expertise to assess patient clinical information and payer clinical standards.

• Analyze patient progress notes, laboratory reports, infusion summaries, imaging results, and care plans.

• Identify medical documentation that meets payer medical policy criteria.

• Request further clinical information as necessary to make decisions or determine subsequent actions.

• Develop clinical support packets for initial prior authorizations and subsequent appeals.

• Construct and document evidence-based clinical cases to support appeals following authorization denials.

• Establish and maintain a library of clinical support materials, appeal templates, journal articles, and reference tools.

• Conduct searches for supporting clinical evidence when existing resources are not available.

• Remain updated on payer-covered services, medical necessity criteria, formulary specifics, and payer medical policies.

• Provide assistance with post-service insurance denials and appeals.

• Engage in outcome programs, including data entry, reporting, and patient communications.

• Deliver interdepartmental training on disease states, specialty medications, clinical requirements, and best practices for prior authorization and appeals.

⛳️ Requirements

• Availability to work Monday to Friday from 8:30 AM to 5 PM Mountain or Pacific time.

• Experience in Specialty Infusion Pharmacy is required.

• Demonstrated experience with denial support, clinical evaluations, and appeals related to infusions and specialty pharmacy.

• Preferred qualifications include Medical Assistant, LPN, or RN credentials.

• A Bachelor’s degree in a healthcare-related field or three years in a relevant position.

• Exceptional communication skills (written, verbal, and presentation), along with strong customer service and interpersonal abilities.

• Adaptable communication style, highly motivated team player with outstanding listening skills.

• Capable of managing stress to achieve identified program objectives and effectively manage time.

• Self-motivated individual who takes initiative, is comfortable with responsibility, and is focused on results.

• Proficient in Microsoft Word, Excel, and PowerPoint.

• Must be able to communicate efficiently with all levels of the organization at Soleo Health.

• Must actively support Soleo Health’s philosophy and objectives.

🏝️ Benefits

• Competitive wages.

• Flexible scheduling options.

• 401(k) plan with employer matching.

• Referral bonus program.

• Paid time off.

• Annual merit-based salary increases.

• No weekend or holiday shifts.

• Affordable medical, dental, and vision insurance plans.

• Company-paid disability and basic life insurance.

• HSA and FSA options, including dependent care.

• Education assistance program.