Clinical Review Coordinator

Why consider this job opportunity:

• Competitive wages with annual merit-based increases
• Flexible schedules with no weekends or holidays
• Comprehensive benefits including affordable medical, dental, and vision insurance plans
• 401(k) with a match and referral bonus opportunities
• Paid time off and an education assistance program
• Work remotely from anywhere in the U.S. within specified hours

• Conduct prior authorization reviews to determine medical necessity based on clinical expertise
• Review patient documentation including progress notes, lab reports, and treatment plans to meet payer criteria
• Request additional clinical information as necessary and assist in creating clinical support packets for appeals
• Document and construct clinical cases for appeal submissions in instances of authorization denials
• Provide training and support across departments to enhance understanding of specialty drugs and prior authorization processes

• Bachelor’s degree in a healthcare field or 3 years of relevant experience
• Experience in denial support, clinical reviews, and appeals for infusion services
• Excellent communication and interpersonal skills
• Proficiency in Microsoft Word, Excel, and Power Point
• Ability to manage stress and effectively meet program objectives

• Experience with patients requiring specialty infusion services
• Strong customer service skills and a flexible communication style
• Ability to work as a motivated team player with excellent listening abilities
• Self-starter attitude with a results-oriented approach
• Familiarity with payer medical policies and resources

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Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.