Clinical Review Coordinator

Job Summary

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

Key Responsibilities

• Complete prior authorization reviews by evaluating patient clinicals and payer criteria to ensure medical necessity
• Review patient documentation to identify necessary medical records that meet payer policy criteria
• Assist with denial appeals by constructing clinical cases and maintaining a library of clinical support resources

Required Qualifications

• Preferred qualifications include Medical Assistant, LPN, or RN
• Experience with specialty infusion pharmacy is required
• Bachelor's degree in a healthcare field or 3 years in a qualified position
• Proficiency in Word, Excel, and PowerPoint
• Ability to manage stress and meet program objectives effectively