Clinical Review Coordinator

Job Summary

A company is looking for a Clinical Review Coordinator to support their Specialty Infusion Pharmacy remotely.

Key Responsibilities

• Completes prior authorization reviews by evaluating patient clinicals and payer criteria for medical necessity
• Reviews patient documentation and identifies necessary medical information for payer compliance
• Constructs clinical cases for appeal submissions and maintains a library of clinical support resources

Required Qualifications

• Bachelor's degree in a healthcare field or 3 years of relevant experience
• Preferred experience with specialty infusion patient needs
• Competent in Microsoft Word, Excel, and PowerPoint
• Experience with denial support, clinical reviews, and appeals for infusions
• Ability to work under stress and manage time effectively