Remote Infusion Clinical Review Specialist

Soleo Health; Texas; Remote; USD 60,000 - 78,000; Full time

Benefits offered by this job

Competitive Wages

Flexible schedules

401(k) with a match

Referral Bonus

Paid Time Off

Annual Merit Based Increases

No Weekends or Holidays

Affordable Medical, Dental, and Vision

Company Paid Disability and Basic Life

HSA and FSA options

Education Assistant Program

Job summary

Soleo Health is seeking an Infusion Clinical Review Coordinator to support our Specialty Infusion Pharmacy and work remotely in the USA. This role focuses on researching and providing timely clinical reviews on complex patient cases to secure approvals and reduce denials.

You will use national criteria for appeals and collaborate across departments. Must have experience with denial support, clinical reviews, and appeals for infusions and specialty pharmacy.

Qualifications

• Excellent communication and interpersonal skills across levels.
• Experience with denial support, clinical reviews and appeals.
• Ability to manage multiple priorities in a fast-paced setting.
• Familiarity with infusion and specialty pharmacy processes.

Responsibilities

• Completes prior authorization reviews using clinical criteria to determine medical necessity.
• Reviews progress notes, labs, infusion summaries, imaging, and plan of care to meet payer criteria.
• Requests additional clinical information when needed to render a decision and determine next steps.
• Assists with creation of clinical support packets for initial prior authorizations and appeals.
• In cases of denials, constructs a succinct clinical case to support appeal using medical necessity criteria.
• Maintains a library of clinical resources (templates, articles) for appeals and evidence.
• Keeps current on payer covered services, medical necessity and formulary details; locates payer resources.
• Supports post-service insurance denials and appeals; participates in data entry and reporting.
• Provides inter-departmental training on disease states, clinical requirements, and best practices.

Skills

Communication

Customer service

Interpersonal skills

Presentation

Stress management

Time management

Self-starter

Education

Bachelor’s degree in healthcare field

3 years in a qualified position

Medical Assistant

LPN

RN

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Soleo Health is seeking an Infusion Clinical Review Coordinator to support our Specialty Infusion Pharmacy and work remotely in the USA. This role focuses on researching and providing timely clinical reviews on complex patient cases to secure approvals and reduce denials.

You will use national criteria for appeals and collaborate across departments. Must have experience with denial support, clinical reviews, and appeals for infusions and specialty pharmacy.