Clinical Review Pharmacist

OI Infusion Services, LLC • Portland, OR

1d • $100,000 - $130,000 • Remote

About The Position

The Clinical Review Pharmacist is the quality gate that ensures every infusion order is clinically appropriate, payer-compliant, and accurately documented before authorization is requested. This role goes beyond medical necessity review: it requires payer policy literacy, sharp attention to detail, proactive case-building for complex and off-label therapies, and hands-on ownership of the denial response process from root-cause analysis through appeal or peer-to-peer support. The right candidate does not simply check boxes against a policy database. They read the full clinical picture, anticipate payer pushback before submission, communicate clearly and specifically with sites and navigators about what is needed and why, and — when a denial occurs — build an airtight case to overturn it rather than placing the burden entirely on the referring provider.

Requirements

• Minimum of four years of infusion pharmacy experience as a pharmacist
• Proficient with Microsoft suite- Word, Excel, Outlook
• Ability to work independently and manage multiple tasks
• Bachelor of Pharmacy or a Doctor of Pharmacy
• Be a pharmacist a current/clear license within the state
• Experience with providing clinical education and support for specialty medications

Nice To Haves

• Minimum 2 years of infusion therapy experience preferred- Hospital, home health, etc.
• Clinical education and support for specialty medications is a plus
• Thrives working in a fast pace working environment

Responsibilities

• Conduct thorough medical necessity review of infusion orders for both commercial and government payers across all designated drug therapies, applying the correct payer-specific medical policy for each case
• Review the full patient chart to determine whether the patient meets payer criteria, including diagnosis, step therapy requirements, lab values, dosing, and continuation-of-therapy documentation
• Maintain and actively use the PGR policy database as the primary source of truth; flag and update policy changes on a quarterly basis in coordination with the Director of RCM
• Apply consistent, templated communication standards when PGR review results in a required action by the site, navigator, or provider.
• Review and verify that each order is correctly dosed flagging dosing discrepancies with ordering providers before moving forward
• When auth denials are received, work with intake leaders to write specifically tailored LMN to overturn the decision when necessary
• Assist the intake team reviewing auth denials with clinical guidance and how to best proceed
• Collaborate with clinical operations team on review and maintenance of order sets and drug preparation sheets to ensure clinical accuracy
• Experience in navigating a fast-paced, high-volume environment with competing priorities and evolving payer landscapes

What This Job Offers

• Job Type: Full-time
• Career Level: Senior