Clinical Review Pharmacist

🔥 0 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

OI Infusion

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

🤝 B2B

💊 Pharmaceuticals

Healthcare • B2B • Pharmaceuticals

OI Infusion is a healthcare services company that partners with medical practices and health systems to establish, manage, and optimize in-office infusion suites nationwide. They handle clinical and business operations including biologic drug procurement, patient authorizations and scheduling, staffing and clinical oversight, and full revenue-cycle management (coding, billing, collections). OI Infusion focuses on improving patient access and outcomes for specialties such as gastroenterology, neurology, rheumatology, and immunology/pulmonology by delivering outpatient infusion therapies in a convenient, office-based setting.

📋 Description

• Conduct thorough medical necessity review of infusion orders for commercial and government payers across designated drug therapies • Review full patient charts for diagnosis, step therapy requirements, lab values, dosing, and continuation-of-therapy documentation • Maintain and use the PGR policy database as the primary source of truth • Flag and update payer policy changes quarterly with the Director of RCM • Apply templated communication standards when review results require action by sites, navigators, or providers • Review and verify order dosing and flag discrepancies with ordering providers • Write tailored letters of medical necessity to overturn authorization denials when necessary • Assist the intake team with clinical guidance on authorization denials and next steps • Collaborate with clinical operations on order sets and drug preparation sheets • Perform duties in a fast-paced, high-volume environment with competing priorities and evolving payer landscapes

🎯 Requirements

• Minimum 2 years of infusion therapy experience preferred • Minimum 4 years of infusion pharmacy experience as a pharmacist preferred • Current and clear pharmacist license within the state • Bachelor of Pharmacy or Doctor of Pharmacy preferred • Proficiency with Microsoft Word, Excel, and Outlook • Ability to work independently and manage multiple tasks • Experience providing clinical education and support for specialty medications is a plus • Ability to thrive in a fast-paced work environment • Ability to evaluate patients against insurance company drug policies for treatment eligibility • Must be legally authorized to work in the United States • Must not require sponsorship now or in the future to work in the United States