Infusion Clinical Review Coordinator
Job Summary
To support a Specialty Infusion Pharmacy, the full-time Infusion Clinical Review Coordinator will work remotely, Monday to Friday, 8:30am to 5pm MST or PST, focusing on conducting clinical reviews of complex patient cases to ensure timely approvals and mitigate denial risks.
Key responsibilities:
- Completes prior authorization reviews by evaluating patient clinicals against payer criteria to determine medical necessity
- Reviews patient documentation and identifies necessary medical information to support authorization requests and appeals
- Creates clinical support packets and maintains a library of resources to assist with appeals and denial resolutions
Required qualifications:
- Preferred qualifications include Medical Assistant, LPN, or RN
- Experience in specialty infusion pharmacy is required
- Bachelor's degree in a healthcare field or 3 years in a qualified position
- Proficient in Word, Excel, and PowerPoint
- Ability to effectively communicate with all organizational levels
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