Infusion Clinical Review Coordinator - Remote

Description Soleo Health is seeking a Clinical Review Coordinator to support our Specialty Infusion Pharmacy and work remotely in the USA. Join us in simplifying complex care! Must be able to work 8:30 a.m. – 5:00 p.m. Eastern Time, Monday‑Friday. Specialty infusion pharmacy experience is required. Key Perks & Benefits 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 insurance plans Company‑paid disability and basic life insurance HSA and FSA (including dependent care) options Education Assistant Program Responsibilities Complete prior authorization reviews in a timely manner, evaluating patient clinicals and payer criteria to determine medical necessity. Review and comprehend patient progress notes, lab reports, infusion summaries, imaging reports, and plans of care; identify documentation meeting payer policies. Request additional clinical information when needed to render a decision and/or determine next steps. Assist with creation of clinical support packets for initial authorizations and subsequent appeals. In cases of denial, construct and document a succinct, fact‑based clinical case for appeal using appropriate medical necessity criteria. Create and maintain a library of clinical support resources, including templates, journal articles, and other references; search for supporting evidence when resources are unavailable. Provide program support by staying current on top payer‑covered services, medical necessity requirements, and formulary details; locate payer resources related to medical policies. Assist with post‑service insurance denials & appeals. Participate in outcome programs, including data entry, reporting, and patient calls required to complete denial support tasks. Provide inter‑departmental training to increase team knowledge on top disease states, specialty drugs, clinical requirements, and prior authorization & appeal best practices. Schedule & Requirements Must be able to work remote, 8:30 a.m. – 5:00 p.m. Eastern Time, Monday‑Friday. Must have experience in denial support, clinical reviews, and appeals for infusions and specialty pharmacy. Preferred qualifications: Medical Assistant, LPN, RN. Experience with specialty infusion pharmacy required. Bachelor’s degree in a healthcare field or 3 years in a qualified position. Excellent written, oral, and presentation communication skills; customer‑service and interpersonal skills. Flexible communication style; highly motivated team player with strong listening skills. Able to handle stress to meet program objectives and manage time effectively. Self‑starter who takes responsibility, is comfortable with accountability, and results‑oriented. Competent in Word, Excel, and PowerPoint. Must communicate effectively with all levels of the organization. Must enthusiastically support Soleo Health’s philosophy and goals. About Soleo Health Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest, as employees are our greatest asset. Experience the Soleo Health difference! Equal Opportunity Statement Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non‑merit factor. Salary $65,000 – $80,000 per year #J-18808-Ljbffr Soleo Health