Infusion Clinical Review Coordinator

🔥 16 hours ago

🇺🇸 United States – Remote

💵 $65k - $80k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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

Soleo Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

Soleo Health is a specialty pharmacy company that goes beyond simply filling prescriptions by providing personalized patient experiences and access to specialized medications and infusion therapies. They offer treatment in patients' homes, in providers' offices, or at one of their many nationwide infusion centers. Soleo Health specializes in treating complex and ultra-rare diseases with a focus on improving patient quality of life and optimizing health outcomes. They work closely with patients, providers, pharmaceutical manufacturers, payors, and health systems to deliver high-cost therapies, demonstrating value through real-world outcome data. Soleo Health is recognized for its clinical excellence and dedication to patient care, and offers nationwide services, including an online portal, Soleo Connect®, for real-time communication.

📋 Description

• Complete prior authorization reviews using clinical expertise to evaluate patient clinicals and payer clinical criteria • Review patient progress notes, lab reports, infusion summaries, imaging reports, and plans of care • Identify medical documentation satisfying payer medical policy criteria • Request additional clinical information when needed to render decisions or determine next steps • Create clinical support packets for initial prior authorizations and subsequent appeals • Construct and document fact-based clinical cases supporting appeals after authorization denials • Create and maintain a library of clinical support resources, appeal templates, journal articles, and reference tools • Search for supporting clinical evidence when existing resources are unavailable • Stay current on payer-covered services, medical necessity requirements, formulary details, and payer medical policies • Assist with post-service insurance denials and appeals • Participate in outcome programs, including data entry, reporting, and patient calls • Provide interdepartmental training on disease states, specialty drugs, clinical requirements, and prior authorization and appeal best practices

🎯 Requirements

• Must be able to work Monday-Friday, 8:30am-5pm Mountain or Pacific time • Specialty Infusion Pharmacy experience required • Must have experience with denial support, clinical reviews, and appeals for infusions and specialty pharmacy • Preferred qualifications are Medical Assistant, LPN, RN • Bachelor’s degree in healthcare field or 3 years in a qualified position • Excellent communication skills (written, oral, and presentation), customer service, and interpersonal skills • Flexible communication style, highly motivated team player with excellent listening skills • Able to handle stress to meet identified program objectives and manage time effectively • Self-starter who takes responsibility, is comfortable with accountability, and is results oriented • Competent in the use of Word, Excel, and PowerPoint • Must be able to communicate effectively with all levels of the organization within Soleo Health • Must enthusiastically support Soleo Health’s philosophy and goals

🏖️ 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